Effect of Short Message System Reminder on Medicine Regime

Effect of Short Message System reminder on adherence with recommended regimen among Ischemic Heart Disease patients.


Ischemic heart disease is the narrowing of coronary artery by a plaque which composed of fat material, according to World Health Organization (WHO) ischemic heart disease (IHD) is the first leading cause of mortality and morbidity worldwide, accounting for 13.3% of death cases (World Health Organization, 2011). 75% of death and 82% of disability adjusted life years (DALY) in low and middle-income countries occur due to IHD (Gaziano, Bitton, Anand, Abrahams-Gessel, & Murphy, 2010), in Jordan IHD account for 18% of death cases, being the first leading cause of death (CDC, 2013). However survival rate of IHD increase recently (Piepoli et al., 2010). Patients discharge to their homes within five days (Saczynski et al., 2010), and the progress of healing after discharge demands an effective care planning, particularly, those who are newly diagnosed with IHD.

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After discharge patients encounter a challenge time (Eshah & Bond, 2009), and life style changes include, adherence with eating heart-healthy diet, adherence with regular physical activity, and adherence with medication have ascertained by American Herat Association and considered from moderate and strong evidence (Eckel et al., 2013). adherence with these recommendations are associated with decrease readmission and mortality rate (Heran et al., 2011) , however few people adhere with recommended guidelines (Martin, Williams, Haskard, & DiMatteo, 2005).

Non adherence, one of the most important obstacle for successful treatment, is a widespread health problem that threat the health and cause a valuable economical burden as well (Martin et al., 2005). Non adherence to healthy lifestyle including eating unhealthy diet, physical inactivity, smoking, and non compliance with medication are known to increase the development and progression of IHD (Danaei et al., 2009). On the other direction adherence with healthy lifestyle would decrease the burden of IHD (Chiuve, McCullough, Sacks, & Rimm, 2006).

Medication adherence refers to ” whether patients take their medications as prescribed, as well as whether they continue to take a prescribed medication” (Ho, Bryson, & Rumsfeld, 2009). Medication non adherence is a major public health problem (Desai & Choudhry, 2013). The immediate time after discharge is a high risk period for non adherence (Baroletti & Dell’Orfano, 2010), in which 24% of patients don’t adhere to their prescribed medication (Jackevicius, Li, & Tu, 2008). After six weeks of discharge one forth of patients didn’t adhere to prescribed medications (Mathews et al., 2012) and 80% on the long term (DiMatteo, 2004). Non adherence to medication lead to progression of the disease, increase readmission, increase mortality rate, and increase health care cost

Smoking is so widespread (WHO,2007), and one of the ten strongest risk factor of IHD (Goff et al., 2013), although non adherence with healthy diet, medication, inactivity all are attributing risk factors for development and progression of IHD, smoking has a significant effect of all risk factor (CDC). Smokers have double to four times to develop IHD than non-smokers (CDC). However quit smoking is the single most effective measure to prevent IHD (Goff et al., 2013).

A strong evidence exist about the casual relationship between diet and IHD (Mente, de Koning, Shannon, & Anand, 2009). Eating unhealthy diet lead to increase blood cholesterol level, developing of hypertension and diabetes mellitus, obesity, and eventually metabolic syndrome which all are modifiable risk factors for IHD (Goff et al., 2013). However eating vegetables, nuts and mono-saturated fatty acid are among protective habits for prevention of IHD progression (Mente et al., 2009).

Non adherence to physical activity in different culture and societies are common (Rodrigues, João, Gallani, Cornélio, & Alexandre, 2013). The proportion of adults who meet the recommended guidelines of American Heart Association (AHA) for regular physical activity has reduced over time (Roger et al., 2012). A recent meta analysis has been shown that an inverse relationship exist between physical activity and increasing risk of IHD; those patients who didn’t do physical activity are 10-20 more risky than who do moderate physical activity and 20-30 more risky than who do high physical activity (Li & Siegrist, 2012).

To decrease the effect of IHD and prevent its progression secondary prevention programs done and rehabilitation centers are found, However few people attend these programs regularly (Bjarnason-Wehrens et al., 2010). Many obstacles hinder the attendance of these programs include logistic barriers like transportation difficulties, financial cost, and embarrassment of attendance (Neubeck et al., 2012). So more feasible, economical, and provide privacy for patient method is required as alternative.

Tele-health, which define as the use of different type of modern information and technology to contribute t clinical support and to improve health (WHO,2009), is more economical, feasible, and provide the patients privacy. The use of mobile is growing faster and faster, and many patients have mobiles (Deng, 2013). Many studies done using technology to improve adherence among patients, especially Short Message System (SMS) in high technologic counties (Dale et al., 2014Khonsari et al., 2014). To my knowledge this is the first study done to assess the effect of use of telehealth in a less technology-dependent countries.

So the purpose of the study is: examine the effect of short message system (SMS) on medication, healthy diet, smoking cessation and physical activity adherence among IHD patients.

Research hypotheses: patients who will receive reminder message will be more adherent to medication, healthy diet , smoking cessation and physical activity than those who will not.


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