Results of a program to send text message reminders to patients with diabetes adds to mounting evidence that mobile technologies hold great promise for enhanced patient support and self-care for chronic conditions.
Over the past few years we’ve been following a pilot project at the University of Chicago Medicine that plugs into the ubiquity of text messaging as a practical way to engage and motivate type 1 and type 2 diabetes patients to better manage the disease and ultimately, lower health care costs. The idea is that patients can enroll in a system that sends gentle reminders via text to check their blood sugar, take their medications and manage what one researcher called the “daily-ness” of living with diabetes.
After a six-month trial, patient data from the initial phase of the project shows improved glycemic control and an 8.8 percent reduction in costs among enrollees in the program. The results add to mounting evidence that mobile technologies hold great promise for enhanced patient support and self-care for chronic conditions between physician visits.
In a study published today in the February issue of Health Affairs, researchers at the University of Chicago Medicine sent daily automated text messages over a six-month period to 74 members of its employee health plan (employees and dependents) who’d been diagnosed with type 1 or type 2 diabetes. The texts contained educational messages including tips on nutrition, glucose monitoring, foot care and exercise along with reminders such as “Time to check you blood sugar” or “Do you need refills of any of your medications?”
The program, called CareSmarts, allowed participants to reply via text to a web-based system that tracked self-care behaviors to determine the needed frequency of reminders. Those replies also facilitated remote monitoring by health plan nurses, who coordinated with a team of primary care physicians and nurses to respond to refill or referral needs, and even arrange for a clinical intervention for more serious issues such as low medication adherence. For instance, if a participant answered “No” when asked if they’ve been taking their medication, a nurse called the patient to offer help.
The outcome of this remote support, say the study authors, was very promising. Hemoglobin A1c levels (HbA1c) decreased from an average of 7.9 percent to 7.2 percent among program enrollees. For those with the most poorly controlled diabetes at the onset of the program, the results were even more substantial – the HbA1c average dropped from 10.3 percent to 8.5 percent after six months of texting.
The study was led by Shantanu Nundy, MD, a former clinical instructor of medicine at the University of Chicago Medicine who is now managing director for program innovations at Evolent Health.
“A lot of people with diabetes do well for a while and then they slip up,” he told Science Life last year. “We don’t have a systematic way of getting people to really buy into what I call the daily-ness of the disease – what it really means to have diabetes and have it every day for the rest of your life. Doctors have very little insight as to what happens to people once they leave our clinic. Just asking the question, ‘Did you take your medicine today?,’ gave us a value piece of information we’d never had before.”
Notably, in addition to improved health outcomes, the program was associated with a significant decrease in health care costs compared to the pre-test period. The total cost of care declined $812 per participant, reflecting a savings of $1,332 in inpatient, outpatient and emergency department visits, offset by a $520 increase in drug costs.
Factoring in the costs to implement the program – $375 per participant for the technology and staffing – the balance was still comfortably beyond favorable. The net savings for the program were $32,388 over six months, an 8.8 percent decrease in total cost compared to the pre-test period. Another big win for the study was patient experience – 73 percent of participants said they were satisfied with the program, with 88 percent pointing to interaction with a health professional as an important factor in their engagement.
“The fact that in a short period of time we were not only able to help patients improve their health and experience costs savings, but they also liked the program is remarkable,” said co-author Monica Peek, MD, MPH, an assistant professor of medicine at the University of Chicago Medicine and associate director of the Chicago Center for Diabetes Translational Research. “To have those three things happen simultaneously is very difficult to do. As health care providers, we need to think more broadly about a patient’s needs, the resources available and how we can offer support in a way that is seamless for the patient, so that we can increase their chance of success. This program hit that mark.”
The researchers says that while they believe they’ve shown a strong case for the use of mobile health (mHealth) by health care organizations in pursuit of better health, better health care, and lower costs, a supportive policy environment is key to diffusion and sustainability of mobile programs. They’re now advocating for increased integration with electronic health records, clearer regulatory guidance, and stronger accountability for population health to unlock mHealth’s full potential.
Nundy S., Dick J.J., Chou C.H., Nocon R.S., Chin M.H. & Peek M.E. (2014). Mobile Phone Diabetes Project Led To Improved Glycemic Control And Net Savings For Chicago Plan Participants, Health Affairs, 33 (2) 265-272. DOI: 10.1377/hlthaff.2013.0589