title: The potential impact of intelligent systems for mobile health self-management support: Monte Carlo simulations of text message support for medication adherence.
abstract: BACKGROUND
  Mobile health (mHealth) services cannot easily adapt to users' unique needs.
  
  
  OBJECTIVE
  We used simulations of text messaging (SMS) for improving medication adherence to demonstrate benefits of interventions using reinforcement learning (RL).
  
  
  METHODS
  We used Monte Carlo simulations to estimate the relative impact of an intervention using RL to adapt SMS adherence support messages in order to more effectively address each non-adherent patient's adherence barriers, e.g., forgetfulness versus side effect concerns. SMS messages were assumed to improve adherence only when they matched the barriers for that patient. Baseline adherence and the impact of matching messages were estimated from literature review. RL-SMS was compared in common scenarios to simple reminders, random messages, and standard tailoring.
  
  
  RESULTS
  RL could produce a 5-14% absolute improvement in adherence compared to current approaches. When adherence barriers are not accurately reported, RL can recognize which barriers are relevant for which patients. When barriers change, RL can adjust message targeting. RL can detect when messages are sent too frequently causing burnout.
  
  
  CONCLUSIONS
  RL systems could make mHealth services more effective.
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA, jpiette@umich.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Karen B
authors.initials: KB
authors.lastname: Farris
authors.forename: Sean
authors.initials: S
authors.lastname: Newman
authors.forename: Larry
authors.initials: L
authors.lastname: An
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sussman
authors.forename: Satinder
authors.initials: S
authors.lastname: Singh
mesh_terms: D003198:Computer Simulation; D006801:Humans; D055118:Medication Adherence; D012648:Self Care; D017216:Telemedicine; D060145:Text Messaging
references.citation: BMJ. 2008 May 17;336(7653):1114-7
references.pmid: 18480115
references.citation: Drug Alcohol Depend. 2007 May;88 Suppl 2:S1-3
references.pmid: 17350181
references.citation: Cochrane Database Syst Rev. 2012 Mar 14;(3):CD009756
references.pmid: 22419345
references.citation: Health Psychol. 2009 Jul;28(4):394-403
references.pmid: 19594262
references.citation: PLoS Med. 2013;10(1):e1001362
references.pmid: 23349621
references.citation: J Assoc Physicians India. 2011 Nov;59:711-4
references.pmid: 22616337
references.citation: Health Educ Res. 2008 Jun;23(3):454-66
references.pmid: 18349033
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: Am J Prev Med. 2009 Feb;36(2):165-73
references.pmid: 19135907
references.citation: Clin Pharmacol Ther. 1990 Dec;48(6):676-85
references.pmid: 2147405
references.citation: Med Care. 2004 Jul;42(7):649-52
references.pmid: 15213489
references.citation: Int J Med Inform. 2012 Sep;81(9):594-604
references.pmid: 22652012
references.citation: J Telemed Telecare. 2010;16(8):458-61
references.pmid: 20959393
references.citation: J Manag Care Pharm. 2009 Nov-Dec;15(9):728-40
references.pmid: 19954264
references.citation: Eur Heart J. 2013 Oct;34(38):2933-9
references.pmid: 23861328
references.citation: J Clin Epidemiol. 2006 Jun;59(6):650-1
references.pmid: 16713529
references.citation: AIDS. 2011 Mar 27;25(6):825-34
references.pmid: 21252632
references.citation: Telemed J E Health. 2009 Apr;15(3):231-40
references.pmid: 19382860
references.citation: J Telemed Telecare. 2011;17(1):41-8
references.pmid: 21097565
references.citation: Am J Manag Care. 2010 Dec;16(12 Suppl HIT):SP82-92
references.pmid: 21314228
references.citation: JAMA. 2007 Jan 10;297(2):177-86
references.pmid: 17213401
references.citation: J Manag Care Pharm. 2006 Apr;12(3):239-45
references.pmid: 16623608
references.citation: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
references.pmid: 18425859
references.citation: IEEE Trans Inf Technol Biomed. 2006 Apr;10(2):323-33
references.pmid: 16617621
references.citation: Br J Health Psychol. 2012 Feb;17(1):74-84
references.pmid: 22107110
references.citation: Patient Prefer Adherence. 2010 Jul 21;4:187-95
references.pmid: 20694180
references.citation: Infect Control Hosp Epidemiol. 2011 Feb;32(2):136-47
references.pmid: 21460468
references.citation: Health Expect. 2011 Sep;14(3):307-20
references.pmid: 20860775
references.citation: Patient Educ Couns. 2011 May;83(2):265-8
references.pmid: 20542401
references.citation: J Psychosom Res. 1999 Dec;47(6):555-67
references.pmid: 10661603
references.citation: Health Commun. 2012;27(1):75-85
references.pmid: 21745039
references.citation: AIDS Patient Care STDS. 2011 Mar;25(3):153-61
references.pmid: 21323532
references.citation: Diabetes Technol Ther. 2009 Feb;11(2):99-106
references.pmid: 19848576
references.citation: Patient Educ Couns. 2011 Jun;83(3):382-90
references.pmid: 21454030
references.citation: BMC Infect Dis. 2009 May 15;9:64
references.pmid: 19445655
references.citation: Arch Dermatol. 2009 Nov;145(11):1230-6
references.pmid: 19917951
references.citation: J Clin Pharm Ther. 2001 Oct;26(5):331-42
references.pmid: 11679023
references.citation: Value Health. 2008 Jul-Aug;11(4):600-10
references.pmid: 18194403
references.citation: J Am Acad Dermatol. 2012 Dec;67(6):1136-42
references.pmid: 22521201
references.citation: JMIR Res Protoc. 2012 Nov 16;1(2):e17
references.pmid: 23612237
references.citation: BMC Cardiovasc Disord. 2006 Aug 30;6:36
references.pmid: 16942618
references.citation: Curr Med Res Opin. 2009 Jan;25(1):215-38
references.pmid: 19210154
references.citation: J Soc Health Syst. 1997;5(3):1-15
references.pmid: 9035020