Listening to patient feedback on their desired communication platform and incorporating their opinions led to the aptly named program Listening to Women and Pregnant and Postpartum People at MUSC Health. The Trauma Resilience and Recovery Program surveyed patients on which methods work best for them to garner their preferences.
Adolescent patients enrolled in a weight management program at MUSC known as Health Chat didn’t want to talk to their providers through an app. And parents of children with ADHD wanted a secure and efficient way to adjust their child’s care without more appointments.
The answer was clear: text messaging was the preferred method of physician communication for patients and caregivers.
And to address that need, reach more patients, and foster engagement as well as adherence, more physicians at MUSC are incorporating text messaging into their programs.
Claire MacGeorge, M.D., MSCR, a general pediatrician and medical director for MUSC Health’s school-based telehealth program, works with students struggling with ADHD. She is currently piloting a text-based communication platform that allows caregivers and teachers to submit information about their child’s symptoms to physicians directly, which in turn helps pediatricians adjust care for these students more quickly and more appropriately.
According to a national survey of parents conducted through the Centers for Disease Control and Prevention, almost 10% of adolescents in the U.S. have been diagnosed with ADHD. And MacGeorge was looking for another way to help both caregivers and students.
By responding to a survey designed to diagnose ADHD – the NICHQ Vanderbilt Assessment – caregivers and teachers can submit symptoms to their health care team via text messaging.
“The hope,” she said, “is that with this tool’s increased communication, pediatricians can feel like they’re able to make better management decisions because they can get information faster and adjust medications faster. They’re able to get each kid into a better place with better symptom control.”
Ken Ruggiero, Ph.D., clinical psychologist and director of the Trauma Resilience and Recovery Program, started by asking his trauma patients their preferred method of communication, and he overwhelmingly found it to be text messaging. The resulting program is now in 16 different hospitals across five different states as well as Washington, D.C., and has been adopted by 11 trauma centers in North and South Carolina.
With a group effort between Ruggiero and colleagues Tatiana Davidson, Ph.D., associate professor, clinical psychologist and codirector of the program, and Leigh Ridings, Ph.D., assistant professor and associate director for child and family services in the program, the team began enrolling their patients in a 30-day text messaging program that also ends with a telephone check-in.
Looking for a way to continue care after patients left the hospital, Ruggiero and his team reach their patients at the start of their at-home recovery and provide wellness tips as well as ways to lower anxiety. Recovering from a severe injury can often lead to changes in mental health, and by receiving text messages about their symptoms, patients pay more attention to their changes in mood. After patients rate their ability to sleep through the night, for instance, physicians can follow up with tips on ways they might get a better night’s sleep.
By gaining these types of insights, health care team members can predict which patients might be at risk for developing PTSD or depression following their injury. “After a patient reports a symptom, tips can include different relaxation strategies like mindfulness exercises, diaphragmatic breathing or progressive muscle relaxing,” Ridings said. “And even different audio clips, videos and games can accelerate their recovery and provide coping strategies.”
As an assistant professor in the pediatrics department at MUSC Children’s Health, Christine San Giovanni, M.D., has also found success with text messaging and increased engagement with her patients. In the weight management clinic, San Giovanni works with adolescents to develop SMART goals. Standing for specific, measurable, attainable, relevant and timely, these ideas help children set goals they can reach and ones they’ll know when they reach.
Goals can range from completing a 10-minute run twice a week or a 15-minute walk 4 times a week to drinking two bottles of water 5 days a week. And San Giovanni says her patients feel more accountable to those goals when they know their provider will check in via text message.
“I wanted a way to help adolescents feel like they were connected with their health care provider and that they could stay engaged with the goals they set,” San Giovanni said. “I didn’t want them to feel isolated.”
Texting also allows pediatricians to know when it’s prudent to push a patient to create a more difficult goal or pull back on one that is not yet attainable.
Right now the program hinges on standardized texts, and while the patient can reply freely their responses, a health care provider is not always on the other side in the moment. They might not be reading their patient’s responses until later. San Giovanni is currently testing a non-automated version where a member of staff would communicate back. She hopes the program can grow to include that aspect.
Another patient population benefiting from a text-based program includes pregnant women. Constance Guille, M.D., director of the Women’s Reproductive Behavioral Health Division at MUSC, developed the program after learning her patients were less likely to use a web-based platform. They preferred text messaging.
The Listening to Women and Pregnant and Postpartum People program allows patients to privately answer screening questions via text message, which is helpful for topics like substance abuse, intimate partner violence, and changes in mood or outlook. After completing the initial screen, health care providers can reach out to suggest treatment. The text messages then continue throughout their pregnancy and even postpartum to continually assess their mental health.
Guille found her patients were more likely to answer these screening questions honestly by text than when asked in person, and she found patients were 5 times more likely to show up to treatment than with in-person referrals to treatment. Even racial disparities in treatment were less prominent with this method: black women and white women were equally likely to make it to treatment within the program.
“The results are incredible,” she said.
With consumers increasingly reporting text message communication as preferable and with the increased security and privacy that come with texting, physicians are looking for ways to incorporate it into their programs. Offering more than just appointment scheduling, texting serves as a way to get accurate and timely symptom reports and allows physicians to adjust care accordingly. And they report more patient engagement and accountability.
MacGeorge and San Giovanni are currently pilot testing their programs but have found positive results early on in their studies. Guille has enrolled over 1,200 women in her program and has reported great success. And Ruggiero hopes his program will continue to grow and be implemented in even more states.
“People want to access information and fill out these surveys with as few as clicks as possible,” MacGeorge said. “And texting seems to be the most responsive way.”
San Giovanni began with an app for communication but quickly found her patients wanted a more direct way to communicate, so she switched to text messaging and found better engagement.
The key to all of this development, though, was listening to patient feedback and incorporating it. San Giovanni looks forward to watching the ways in which her program can grow with text messaging and with patient feedback.
Progressnotes Winter 2023
