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Prof Case Manag ; 26(5): 250-254, 2021.
Article in English | MEDLINE | ID: covidwho-1354348


PURPOSE: To review current literature on texting as a sustainable intervention of case management in the outpatient setting. FINDINGS: Texting, as a case management intervention, provides the medically complex client with a pathway to achieve care plan goals. Texting increases adherence, communication, and self-management. It can increase client enrollment in disease management programs, while providing support, flexibility, convenience, cost savings, and increased participation. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: In current practice, such as management of the coronavirus (COVID-19), other pandemics, or natural/environmental disasters, texting is a solution-focused intervention that can deliver and retrieve real-time information to a medically complex population. It can link patients to resources and increase outreach, efficiency, quality, and coordination of care. Texting can promote adherence to appointments, increase medication compliance and disease management interventions, and provide motivational change messages. However, there are legal and regulatory concerns that carry potential consequences and implications that should be approached judiciously (Mellette, 2015). Texting is not one size fits all; it can cause HIPAA breeches, hinder communication with certain populations, confuse health messaging, and replace human communication, thereby reducing staffing in practice.

Ambulatory Care/standards , Case Management/standards , Communication , Guidelines as Topic , Health Insurance Portability and Accountability Act/standards , Telemedicine/standards , Text Messaging/standards , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , United States
J Med Internet Res ; 22(12): e22493, 2020 12 03.
Article in English | MEDLINE | ID: covidwho-1186721


BACKGROUND: Automated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management. OBJECTIVE: Our primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control. METHODS: This study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP. RESULTS: We observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001). CONCLUSIONS: We identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control.

Blood Pressure/physiology , Hypertension/therapy , Monitoring, Physiologic/methods , Text Messaging/standards , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Phenotype , Young Adult
Fertil Steril ; 115(5): 1156-1158, 2021 05.
Article in English | MEDLINE | ID: covidwho-1171964


The prevalence and ease of electronic communication, specifically email through patient portals associated with electronic medical records or via traditional enterprise email clients (e.g., Outlook) and video, have resulted in increased use for rapid communication between practitioners and their patients. Concerns regarding patient privacy and compliance with the regulations of the Health Insurance Portability and Accountability Act (HIPAA) remain a barrier to routine incorporation of electronic communication into practice. Furthermore, capital investment, implementation, and maintenance costs may provide additional barriers. These long-standing concerns have been heightened and tested by the COVID-19 pandemic. Best-practice guidelines for the secure and safe use of electronic communication with reproductive care patients are provided.

Confidentiality/standards , Electronic Mail/standards , Reproductive Medicine/standards , Telemedicine/standards , Text Messaging/standards , Video Recording/standards , COVID-19/epidemiology , Electronic Health Records/standards , Guideline Adherence/standards , Humans , Reproductive Medicine/methods , Telemedicine/methods , Video Recording/methods