Diapositiva 1

A TEXT MESSAGE SUPPORT PROGRAMME for DISCHARGED PATIENTS

RATIONALE

Hospitals are oversubscribed

Much of that demand is preventable re-visits

Re-visits more likely when discharge communications fraught

Overstretched doctors & nurses can not be relied upon to spend more time explaining instructions to patients

SOLUTION m-health-mediated discharge instructions

To assess the impact of a mobile phone text messaging intervention (TXT Rx) on patients discharged from a large urban, multiethnic emergency department.

We designed a mobile phone text messaging intervention (TXT Rx) which represents a cost-effective, patient-centred form of post-discharge care.

We aim to assess the impact of TXT Rx on the level of self management knowledge, treatment adherence and hospital satisfaction in patients discharged from Middlemore Hospital ED.

Data from this study will inform the development and design of our further research studies focused on use of tailored, text messaging case management programmes to promote illness/symptom self-management, and provide support and monitoring cost-effectively to discharged ED patients.

Multiple stakeholders at all levels were informed about the study and were supportive of it. These include ED doctors and nurses, senior management staff from ED, clinical pharmacy, internal medicine, MMH CEO, Board of Directors. A feasibility study (Larkin, unpublished) was also conducted on a sample of ED patients on their willingness to send and receive text messages from the hospital. Findings suggest interest and enthusiasm from patients of different ages, education, ethic groups.

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OUR STUDY

AIMTo assess impacts of a cellphone text messaging intervention (TXT Rx) on ED patients: Adherence w/ prescribed meds Adherence w/ follow-up appointmentsSatisfaction w/ care 30-day ED re-visit rate

To assess the impact of a mobile phone text messaging intervention (TXT Rx) on patients discharged from a large urban, multiethnic emergency department.

We designed a mobile phone text messaging intervention (TXT Rx) which represents a cost-effective, patient-centred form of post-discharge care.

We aim to assess the impact of TXT Rx on the level of self management knowledge, treatment adherence and hospital satisfaction in patients discharged from Middlemore Hospital ED.

Data from this study will inform the development and design of our further research studies focused on use of tailored, text messaging case management programmes to promote illness/symptom self-management, and provide support and monitoring cost-effectively to discharged ED patients.

Multiple stakeholders at all levels were informed about the study and were supportive of it. These include ED doctors and nurses, senior management staff from ED, clinical pharmacy, internal medicine, MMH CEO, Board of Directors. A feasibility study (Larkin, unpublished) was also conducted on a sample of ED patients on their willingness to send and receive text messages from the hospital. Findings suggest interest and enthusiasm from patients of different ages, education, ethic groups.

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DESIGNRCT at Middlemore EDEvaluators blinded Patients recruited at ED dischargeRandomized to intervention or control groupBoth groups got text messages for 7 days

Control msgs

Generic public health msgs

Smoking killsSeatbelts save lives Immunisation protects Drunk driving killsIntervention msgsDx and Rx educationScript pick up reminderAppt, meds, treatment remindersTexts to check on wellbeing

Usually exclude participants who cannot speak/understand/read English but 1-2 participants recruited were interviewed and texted in Chinese researchers native language

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TXT RxParticipants in intervention group receive 3-5 text msgs per day (plus replies) over a period of 7 days.

Welcome text within 24 hours of ED discharge

Diagnosis

Medication name plus prescribed dosage

Intervention and control patients receive different types of text messages, in addition to standard care. Intervention arm participants will receive the TXT Rx programme with several types of messages (3- 5 per day) for 7 days. The types of messages include medication reminders, appointment reminders, knowledge text about their disease category, and an Ecological Momentary Assessment (EMA) msg asking patients to rate how they are feeling on a 1-9 scale of 1 never felt worse to 9 never felt better. The Txt Rx intervention provides participants with real-time feedback to their text responses. For example; the system query: did you pick up your prescription medication? was answered with a yes or no the yes elicited a psotive response and a no elicted a further reminder to please get your prescription filled asap and pls text us back as soon as you have it.Control participants, on the other hand, receive one generic health message daily for 7 days.

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TXT Rx COMMUNICATIONS

PARTICIPANTSN = 520Intervention: n = 291 (56.6%) Control: n = 223 (43.4%) Ethnicity %European/Pakeha 31.9Maori 19.5Pacific 15.8Indian 8.3Asian 2.5Unknown/Other 22.5Age Range:16-84 yrs Female 48.8% Disease categories %Injury 30.5Pain syndromes 42.7Infection 23.3Asthma/COPD 3.6

RESULTS: 1Picked up Prescribed Medication from Pharmacy* Intervention vs. Controls

OR =10.3 95% CI: (4.7-22.4) p