Impact of SMS messaging on medication adherence in high utilizing patients

Principal Investigator: Anna Doubeni, MD, MPH

Patients with high utilization of emergency departments and inpatient care represent a population with high-risk social determinants of health (e.g. poverty, food insecurity, unstable housing, minimal support structures) and a high burden of mental health disorders. High ED/inpatient utilization leads to fragmented, high-cost care without improvement in health outcomes. Penn Family Care developed an intervention for ED superutilizer patients. Supported by the Innovations Accelerator program, using a state-of-the-art monitoring platform, we are able to identify patients in real time, track utilization patterns, drivers, and outcome analytics. Using Way to Health to provide appointment reminders, weekly check-ins, and medication reminders, we demonstrated enhanced patient engagement using a bi-directional texting platform and reductions in utilization compared with more traditional care coordinator phone-based outreach.

In this pilot we will enroll 50 patients with > 5 ED visits in 12 months, a diagnosis of depression or anxiety, and a SMS messaging enabled phone. Patients will receive a monthly incentive to assist with text messaging costs. Using propensity score matching, study patients will be matched to patients receiving usual care. The control group will be blinded from the monitoring platform to assure receipt of usual care. Following a 6-month intervention period we will analyze process (i.e. patient engagement) and outcome (i.e. medication adherence, ED/hospital utilization) metrics for the intervention group compared to their a.) pre-intervention patterns, and b.) those of matched controls. We will also analyze the positive predictive value of using bi-directional text messaging to assess depression and anxiety scores on pre-emptive clinical interventions.