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Rural hospital study found text messaging intervention significantly improved medication adherence for heart failure patients, demonstrating that simple technology can reduce readmissions.
Patients with congestive heart failure who received text messages after leaving the hospital reminding them about their prescriptions had 19% higher odds of filling those prescriptions and 6% lower odds of hospital readmission, according to a study published Dec. 31, 2025, in PLOS Digital Health.
Medication nonadherence is high among patients with heart failure. A study of almost 128,000 patients with heart failure in England found that 43.6% of patients were nonadherent to therapy. Nonadherence was associated with a higher all-cause mortality and mortality attributable to cardiovascular disease or heart failure.
Congestive heart failure patients face significant challenges with medication adherence, with studies showing that 40% to 60% don’t take their medications as prescribed, Ben Long, M.D., director of Hospital Medicine at Magnolia Regional Health Center, said in a news release. “Historically, nearly one in four of these patients is readmitted within 30 days, which creates financial pressures on rural hospitals like ours through Medicare penalties.”
The study published in PLOS Digital Health was conducted by Magnolia Regional Health Center, a 200-bed acute care community hospital jointly owned by the City of Corinth and Alcorn County, Mississippi.
Patients were sent a text message five minutes after it was submitted to the hospital’s electronic health record. The messages were sent using DrFirst’s prescription engagement solution directly from the MEDITECH Expanse e-prescribing workflow.
Each message was customized with the patient’s prescriber information and included a link where patients could view medications that were sent to the pharmacy and find copay assistance when available.
Long and his colleagues retrospectively analyzed 1,276 patients with heart failure over a 27-month period, comparing patients who interacted with text messages with those who did not. Patients were grouped into three categories: no subsequent emergency department visit, a return visit to the emergency department within 30 days of the visit with a primary diagnosis of congestive heart failure, and those who were readmitted within 30 days of the visit with a primary diagnosis of congestive heart failure.
They found that text reminders are a simple tool that can be scaled to help patients remember to get their prescriptions. “Even small improvements in medication adherence could prevent emergency room visits and hospitalizations, ultimately improving patients’ quality of life,” researchers wrote.
Other findings include:
• 92% patient engagement rate
• Only 7.7% of patients chose to stop receiving notifications.
• Those previously hospitalized who engaged with text reminders showed a 52% increase in odds of filling prescriptions.
The best results of the text messaging were among patients who had been readmitted to the hospital, said Weston Blakeslee, Ph.D., is VP of clinical intelligence at DrFirst, which provides healthcare technology solutions.
The text messages are not just simple reminders but targeted messaging for patients, he said in an interview. “There’s a link to a microsite where they get education, they get cost-savings options, and they get reminders to fill their medications. By targeting those three pillars of forgetfulness, cost and why they should be taking this medication, we believe we'd make the most impact.”
Even hospitals in rural communities can drive improvements in patient outcomes with technology, Blakeslee said. “Magnolia Regional sits in Northeast Mississippi, far from a major city. Even in these small, rural areas, you don’t need to have the resources of these larger academic medical centers. Text messaging is a simple concept that's easy to implement for hospitals and easy to engage with on the patient side, but it can have a sizable impact, especially in this high-risk patient population.”

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