March 11, 2014
Nearly everyone these days can be found pecking away on a mobile phone, figured researchers at the University of Chicago Medical Center, so why not use a text-based support program to instantly deliver personalized health information aimed at helping diabetics manage the disease?
The researchers recently tested their mobile health platform on 74 diabetics enrolled in the medical center’s employee health plan. Patients received texted prompts to check blood sugar levels, perform proper foot care, and fill medication prescriptions. They also answered self-assessment questions. Responses outside of pre-programmed parameters triggered low-level alerts related to care coordination issues or high-level alerts related to poor self-reported medication adherence.
According to the study, patients sent and received between 2 and 7 texts per day, and responded to a little more than half of the self-assessment questions, a response rate that remained consistent throughout the 6-month study period.
Text-based communication improved patients’ weekly self-care in several key areas: Days of healthy eating increased from 4.5 to 5.2; days of reported glucose monitoring increased slightly from 4.3 to 4.9, and days of proper foot care rose from 3.6 to 4.3. Additionally, adherence to diabetes medication jumped from 83% to 91%.
Overall glycemic control also improved: Average HbA1c decreased from 7.9% to 7.2% over the 6 months. Patients with poorly controlled diabetes before the program started realized an even bigger HbA1c drop: from 10.3% to 8.5%.
The researchers noted the number of emergency room and outpatient visits decreased over the study period. They further noted that the total net cost of health care declined by $437 per participant, which was associated with a total cost savings of $32,388 — a nearly 9% drop.
Managing chronic diseases remains a significant problem for health systems, the researched explained, and failing to transition away from hospital-centric care jeopardizes patient outcomes and ultimately strains healthcare resources.
The key to supporting patients is to connect with them beyond hospital walls and between clinical visits, they said, but current remote care management options or self-care classes are labor intensive, ineffective or unsustainable due to poor patient engagement and lack of integration into clinical care.
In contrast, the researchers highlighted several benefits of their mobile health platform: it engaged patients daily; patients were not overwhelmed with participation requirements and could access the program from anywhere; and it emphasized self-management instead of barraging patients with clinical care messages.
Text-based communication can also be used to refer patients to additional health-system resources, pointed out study co-author Dr. Monica Peek, an assistant professor of medicine at the University of Chicago. “For some healthcare settings and health plans, those additional resources could include education about their medications from pharmacists,” she explained. “We did not include that as part of our program, but such a design is feasible.”
The study was published online in the journal Health Affairs.