One thing’s for sure in today’s world: There’s no shortage of ways to communicate.
But can the new age of communications help in the treatment of rheumatic patients, who are frequently older and, either due to a generation gap or disease-related physical limitations, might find text-messaging not-so-LOL?
A recent study out of the United Kingdom yields some findings that suggest that e-mailing and text messaging might actually have a place in treating people with rheumatic disorders.
In the study—dubbed “Not 2 old 2 TXT”—researchers surveyed 112 rheumatology patients in Hertfordshire, a county north of London.1 The survey was meant to gauge their current use of the Internet, e-mail, and text messaging and to assess their willingness to receive electronic reminders—for things like appointments and medication reminders—in the future.
They found that up to age 55, more than 90% of the patients accessed the web and sent or received text messages at least once a week. This fell to 70% for patients 55 to 64 years old, and to less than 50% for patients over 65.
“So up to age 65, a high proportion of the clinical population is already using the Internet and mobile phones,” says lead author Lyndsay Hughes, MBPsS, lecturer in health psychology at the Institute of Psychiatry, King’s College London. She was at the Centre for Lifespan and Chronic Illness Research, University of Hertfordshire at the time of the study.
She notes that the proportion of the rheumatology patients using the technology within each age group is no different than the percentages in the general population. Also, limitations on their physical abilities didn’t appear to be a deterrent to the use of the technology, she says.
“It has been assumed that the disability that these patients face because of their illness would be a barrier to using technology,” Dr. Hughes says. “However, although a small number of patients reported experiencing problems using a computer mouse and pressing the small buttons on a mobile phone, they managed to overcome these barriers and continue to use the technology.”
Just one patient said that they didn’t use computers because of disease-related constraints, but no one reported not using cell phones because of them.
Appointment Reminders
More than half—56%—of the patients with an e-mail address, and 48% of patients with a mobile phone, said they’d be willing to receive an appointment reminder. That came out to 44% of all the patients, because so many of them are using the technology already. But just 26% percent said they’d be willing to get a reminder to take their medication via either e-mail or text message.
Patients under 65 years old were more likely to be willing to receive a text-message medication reminder than those over 65, but there was no difference by age for e-mail reminders.
When it comes to appointment reminders, Dr. Hughes notes, the younger patients might be more in need of text-message reminders, anyway.
“Although this survey found that the number of patients over 65 with access to ICT [information and communications technology] reduced to less than 50%, the patients that miss appointments tend to be younger and working, indicating that those who would most benefit from this type of reminder are already familiar with the technology,” Dr. Hughes says.
The survey did not try to ascertain whether patients currently using the technology would be willing to try it for medical reminders, and health outcomes resulting from the use of the technology weren’t tracked.
Other Text Message Studies
However, there is some evidence that text messaging works for appointment reminders. The researchers recently did a pilot study on appointment reminders and found that 60% of patients offered an appointment reminder by text message requested one, and 85% of them subsequently attended their appointment.2 Interestingly, 25% of those patients admitted that they would not have attended had they not gotten the reminder.
“Patients indicated that having all the relevant information available on their phones (date, time, location, details to cancel or reschedule) increased the salience of the appointment and reduced the possibility of increasing waiting times by having incorrect information,” Dr. Hughes says.
Dr. Hughes is planning further investigations involving medication reminders and reminders for blood-test monitoring, which, if done in a timely manner, means that results can be discussed during appointments.
Studies have found text messaging to be helpful when the right patients are engaged.
A Michigan State University study found that having teenagers complete a text-messaging survey while in the waiting room proved to be a successful way to screen for unhealthy behaviors, including hazardous alcohol drinking.3
An analysis of four randomized controlled trials involving 3,547 patients found that there is evidence of moderate quality that mobile phone text-message appointment reminders are more effective than no reminders, and low-quality evidence that text messages are better than reminders that come in the regular mail.
The study also found moderate-quality evidence that text messages are just as effective as reminders by phone, with a lower associated cost.
But overall, the evidence either way is limited, the researchers say.
Thomas Geppert, MD, a rheumatologist at Rheumatology Associates in Dallas, says he uses a system in which his patients can reach him by e-mail, which he says is more efficient than the telephone.
He says he can imagine using text messaging for weekly or monthly reminders, but not for daily medications.
“One of the problems we have is the privacy laws,” he says. “Having to put a password on the system makes it harder for patients to use it, and many of them choose not to use it. It seems like a small thing, but the extra steps involved make it cumbersome for older patients and they are easily scared off.”
Thomas Collins is a freelance medical writer based in Florida.
References
- Hughes LD, Done J, Young A. Not 2 old 2 TXT: There is potential to use email and SMS text message healthcare reminders for rheumatology patients up to 65 years old. Health Informatics J. 2011;17:266-276.
- Car J, Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2012 Jul 11;7:CD007458.
- Ríos-Bedoya CF, Hay C. Feasibility of using text messaging for unhealthy behaviors screening in a clinical setting: A case study on adolescent hazardous alcohol use. J Am Med Inform Assoc. 2012 Jul 3. [Epub ahead of print]
