Health Policy and Health Services Research
Background: Mobile health (mHealth) - the use of mobile phones to provide medical care and education - offers a low-cost way to integrate a patient's’ friend or family member into their diabetes management. ED-based mHealth programs have reduced ED utilization, but none have involved a family or friend as a social supporter. Increasing social support has been shown to improve health outcomes, particularly in lifestyle-dependent conditions such as diabetes. In this study, we examine changes in healthcare utilization for ED patients enrolled in an mHealth intervention designed to improve social support and diabetes self-care
Methods: We recruited ED patients with HbA1C≥8.5 and a patient-designated supporter. All patients received TExT-MED, a mHealth program for patients with diabetes. Supporters were randomized to receive a curriculum (FANS intervention, Family And friends Network Supporter) of social support text messages or the same FANS curriculum in pamphlet form (active control). We reviewed electronic medical records to determine the change in scheduled clinic visits, Emergency Department/Urgent Care Center (ED/UCC) visits, and hospitalizations in the 6 months preceding and following first intervention text-message.
Results: Of 113 patients who completed 6 months of the intervention, 112 had follow-up data for analysis, 1 patient excluded for >40 ED visits in study period. Overall, patients increased scheduled clinic visits (mean increase 1.4 visits, (95%CI 0.4 to 2.4 ,p<0.001))and decreased ED/UCC visits (mean decrease -1.1 (95%CI -1.5 to -0.7,p<0.01)). Compared to the active control, TExT-MED+FANS did not significantly change clinic visits, ED/UCC visits, or hospitalizations. Both arms combined exhibited a trend towards decrease in hospitalizations (mean decrease 0.14 hospitalizations, p=0.14).
Conclusion: Overall, the TExT-MED intervention led to a significant decrease in Emergency Department or Urgent Care Center utilization and increased scheduled clinic appointments. This intervention directed patients towards less costly care venues. The modest decrease in hospitalizations suggests another potential avenue of health savings. Through reducing the number of unplanned care visits for uncontrolled diabetes, mHealth can reduce costs to health care systems and hospitals, in addition to improving patients’ health.