Kershaw Karyn, Martelly Lisa, Stevens Cassidy, McInnes D Keith, Silverman Allie, Byrne Thomas, Aycinena Diana, Sabin Lora L, Garvin Lynn A, Vimalananda Varsha G, Hass Robert
Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
Department of Health Communication and Promotion, Boston University School of Public Health, Boston, MA, USA.
Digit Health. 2022 Oct 9;8:20552076221129729. doi: 10.1177/20552076221129729. eCollection 2022 Jan-Dec.
To assess the feasibility and effectiveness of text messaging to increase outpatient care engagement and medication adherence in an urban homeless population in Boston.
Between July 2017 and April 2018, 62 patients from a clinic serving a homeless population were sent automated text messages for four months. Messages were either appointment reminders and medication adherence suggestions (intervention group) or general health promotion messages (control group). Medical records were reviewed to evaluate appointment keeping, emergency room (ER) use, and hospitalizations. Pre- and post-surveys were administered to measure self-reported medication adherence.
No significant differences were found in inpatient or outpatient care between the intervention and control groups, though differences in no-show rates and medication adherence approached significance. Appointment no-show rates were 21.0% vs. 30.6% ( = 0.08) for intervention and control, respectively, and rates of completed appointments were 65.8% vs. 56.7% ( = 0.12). Mean ER visits were 3.86 vs 2.33 ( = 0.16) for intervention and control groups, and mean inpatient admissions were 0.6 versus 1.24 ( = 0.42). Self-reported medication adherence increased from 8.27 to 9.84 in intervention participants, compared to an increase from 8.27 to 8.68 in control participants ( = 0.07), on a 1-11 scale.
Text messaging showed the potential to improve patient engagement in care and medication adherence in an urban homeless population (findings approaching but not achieving statistical significance). Work is needed to enhance the effectiveness of text-messaging interventions, which may involve increasing ease of use for mobile phones and texting apps, and addressing high rates of phone theft and loss.
评估短信提醒对提高波士顿城市无家可归人群门诊护理参与度和药物依从性的可行性和有效性。
2017年7月至2018年4月期间，向一家为无家可归人群服务的诊所的62名患者发送了为期四个月的自动短信。短信内容要么是预约提醒和药物依从性建议（干预组），要么是一般健康促进信息（对照组）。查阅医疗记录以评估预约遵守情况、急诊室（ER）使用情况和住院情况。进行前后调查以测量自我报告的药物依从性。
干预组和对照组在住院或门诊护理方面未发现显著差异，尽管失约率和药物依从性的差异接近显著水平。干预组和对照组的预约失约率分别为21.0%和30.6%（P = 0.08），完成预约的比例分别为65.8%和56.7%（P = 0.12）。干预组和对照组的平均急诊就诊次数分别为3.86次和2.33次（P = 0.16），平均住院次数分别为0.6次和1.24次（P = 0.42）。在1-11分的量表上，干预组参与者自我报告的药物依从性从8.27提高到9.84，而对照组参与者从8.27提高到8.68（P = 0.07）。
短信提醒显示出提高城市无家可归人群护理参与度和药物依从性的潜力（研究结果接近但未达到统计学显著性）。需要开展工作以提高短信干预的有效性，这可能包括提高手机和短信应用程序的易用性，以及解决手机被盗和丢失率高的问题。
