Som Avik, Patel Kunjan, Sink Eric, Peters Robert Mattson, Javaherian Kavon, Groenendyk Jacob, An Tonya, Xu Zhuchen, Polites Gregory M, Blanchard Melvin, Ross Will
Washington University School of Medicine, St. Louis, MO, United States.
Saint Louis University School of Medicine, St. Louis, MO, United States.
JMIR Form Res. 2017 Sep 18;1(1):e2. doi: 10.2196/formative.7211.
Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. One method to improve therapeutic adherence is to improve feedback loops in getting clinically acute events and issues to the relevant clinical providers as necessary (ranging from detecting hypoglycemic events for patients with diabetes to notifying the provider when patients are out of medications). Patients often don't know which information should prompt a call to their physician and proactive checks by the clinics themselves can be very resource intensive. We hypothesized that a two-way SMS system combined with a platform web service for providers would enable both high patient engagement but also the ability to detect relevant clinical alerts.
The objectives of this study are to develop a feasible two-way automated SMS/phone call + web service platform for patient-provider communication, and then study the feasibility and acceptability of the Epharmix platform. First, we report utilization rates over the course of the first 18 months of operation including total identified clinically significant events, and second, review results of patient user-satisfaction surveys for interventions for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties.
To test this question, we developed a web service + SMS/phone infrastructure ("Epharmix"). Utilization results were measured based on the total number of text messages or calls sent and received, with percentage engagement defined as a patient responding to a text message at least once in a given week, including the number of clinically significant alerts generated. User satisfaction surveys were sent once per month over the 18 months to measure satisfaction with the system, frequency and degree of communication. Descriptive statistics were used to describe the above information.
In total, 28,386 text messages and 24,017 calls were sent to 929 patients over 9 months. Patients responded to 80% to 90% of messages allowing the system to detect 1164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions to over 10 on average in any given month for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties.
Engaging high-risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement with very low risk to improve clinical outcomes. We demonstrated that engagement among high-risk populations is possible when health care comes conveniently to where they are.
患者不遵守治疗、处理措施和预约安排是改善医疗服务提供及降低医疗成本的重大障碍。一种提高治疗依从性的方法是改善反馈回路，以便在必要时将临床急症事件和问题传达给相关临床医护人员（从检测糖尿病患者的低血糖事件到患者药物用完时通知医护人员）。患者通常不知道哪些信息应促使他们致电医生，而诊所自行进行的主动检查可能会耗费大量资源。我们假设，一个双向短信系统与一个面向医护人员的平台网络服务相结合，既能提高患者参与度，又能检测到相关临床警报。
本研究的目的是开发一个可行的双向自动化短信/电话+网络服务平台，用于患者与医护人员之间的沟通，然后研究Epharmix平台的可行性和可接受性。首先，我们报告运营前18个月的使用率，包括总共识别出的具有临床意义的事件；其次，审查针对糖尿病、慢性阻塞性肺疾病（COPD）、充血性心力衰竭、高血压、手术部位感染及母乳喂养困难患者的干预措施的患者用户满意度调查结果。
为了验证这个问题,我们开发了一个网络服务+短信/电话基础设施（“Epharmix”）。根据收发的短信或电话总数来衡量使用结果，参与率定义为患者在给定一周内至少回复一次短信的比例, 包括生成的具有临床意义的警报数量。在18个月内每月发送一次用户满意度调查问卷，以衡量对系统（的满意度）、沟通频率和程度。使用描述性统计来描述上述信息。
在9个月内，总共向929名患者发送了28386条短信和24017个电话。患者回复了80%至90%的短信，使系统能够检测到1164起具有临床意义的事件。患者报告称对医护人员的满意度提高且沟通增多。对于糖尿病、COPD、充血性心力衰竭、高血压, 手术部位感染及母乳喂养困难患者，Epharmix使患者与医护人员每月的互动次数平均增加到10次以上。
让高危患者参与仍然是一个困难的过程，可能需要通过新颖的数字健康干预措施来改善。Epharmix平台能够以极低风险提高患者参与度，从而改善临床结果。我们证明，当医疗服务便捷地送达高危人群所在之处时，让他们参与进来是可行的。
