Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States.
School of Nursing, University of Texas at Austin, Austin, TX, United States.
JMIR Mhealth Uhealth. 2021 Nov 3;9(11):e25553. doi: 10.2196/25553.
People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers.
This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital.
This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention.
In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends.
mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.
在急诊部门（ED）或医院就诊后，无家可归者可能会出现护理方面的差距，这会导致使用量增加、健康状况恶化和医疗保健费用增加。大多数无家可归者都拥有某种类型的手机，这使得移动健康（mHealth）干预措施成为一种可行的方式，可以将无家可归者与提供者联系起来。
本研究旨在调查一种基于 GPS 的移动健康（GPS-mHealth）干预措施的准确性、可接受性和初步结果，该措施旨在在无家可归者进入 ED 或医院时提醒社区卫生护理人员。
这是一项前后对照设计的研究，有基线和 4 个月的随访评估。符合条件的参与者为：无家可归者，至少服用 2 种治疗慢性病的药物，PHQ-9 评分至少为 10 分，并且在过去 6 个月内至少有 2 次 ED 或医院就诊。参与者会被发放一部带有 GPS 应用程序的研究智能手机，该程序会在参与者进入 ED 或医院时向社区卫生护理人员发出警报。对于每个警报，社区卫生护理人员都会通过电话进行随访，以评估护理协调需求。参与者还会收到一封每日电子邮件，以评估药物依从性。将 GPS 警报与当地健康信息交换（HIE）中的 ED 和医院数据进行比较，以评估准确性。使用配对 t 检验比较 PHQ-9、医疗结局研究社会支持调查和依从性起始于知识-12 依从性调查在基线和退出时的得分。半结构式退出访谈探讨了干预措施的看法和益处。
共有 30 名参与者入组，平均年龄为 44.1（9.7）岁。大多数参与者为男性（20/30，67%）、白人（17/30，57%）和无业（19/30，63%）。只有 19%（3/16）的 ED 或医院就诊警报与 HIE 数据一致，主要原因是患者在就诊时未携带智能手机、智能手机未开机以及 GPS 技术存在差距。在抑郁症状方面，从基线（均值 16.9，标准差 5.8）到退出（均值 12.7，标准差 8.2；t=2.9；P=.009）和在依从性障碍方面，从基线（均值 2.4，标准差 1.4）到退出（均值 1.5，标准差 1.5；t=2.47；P=.03），差异均有统计学意义。参与者认为该应用程序易于使用（均值 4.4/5，标准差 1.0，5 表示非常同意），电子邮件有助于他们记住服药（均值 4.6/5，标准差 0.6）。定性数据表明，无限制地使用智能手机可以满足参与者的社交需求，并与病例经理、医疗保健提供者、家人和朋友保持联系。
移动健康干预措施可被无家可归者接受。HIE 数据提供了更准确的 ED 和医院就诊信息；但是，无限制地获得可靠的通信手段为参与者带来了超出研究目的（改善护理协调）的益处。
