Elsevier

Academic Pediatrics

Volume 18, Issue 6, August 2018, Pages 636-641
Academic Pediatrics

Educational Text Messages Decreased Emergency Department Utilization Among Infant Caregivers: A Randomized Trial

https://doi.org/10.1016/j.acap.2018.02.003Get rights and content

Abstract

Objective

To determine the feasibility and effectiveness of text messages as an educational tool to reduce the prevalence of nonurgent emergency department (ED) visits among a population with high levels of low health literacy.

Methods

This prospective, randomized experiment conducted in a large, urban, academic pediatric primary care practice enrolled 231 caregivers of infants into 2 groups: enhanced standard of care materials at well-child visits through 6 months (n = 99 completing), and enhanced standard of care and 4 text messages a week through 6 months (n = 108 completing). Use of the ED and visit urgency were compared between groups via chart review at 1 year of age.

Results

Of the 230 included in the analysis, 84.2% (n = 194 of 230) were racial or ethnic minorities, 69.7% (n = 142 of 204) reported yearly incomes of less than $20,000 per year, and 70.4% (n = 142 of 204) were identified as having likely or probable limited health literacy. Participants who received text messages had fewer visits to the ED in their first year (2.14 visits in the control group to 1.47 visits in the intervention group who received text messages; P < .05).

Conclusions

Sending educational text messages to caregivers is effective in reducing the number of visits to the ED. Given the accessibility and small expense of sending text messages, these findings have direct implications on the cost of health care, in addition to improving continuity and quality of care for pediatric patients.

Section snippets

Study Participants

Caregivers of newborns (0–10 weeks of age) receiving primary care at a single urban high-volume (22,000 visits per year across 9500 empaneled patients) academic primary care clinic were recruited for participation. This primary care practice is the sole academic pediatric practice at a midsized university in the Midwest; it is colocated in a children's hospital and affiliated with a larger regional health care network. Caregivers—including biological parents, family members, and foster

Results

A total of 231 participants were enrolled onto the study, 114 in the ESoC group and 117 in the ESoC + Text group. Twenty-four subjects did not complete the intervention (15 from the ESoC group and 9 from the ESoC + Text group); only one of these participants was not included in the final analysis for the ESoC because the infant died (Fig. 2). Because of the changing nature of mobile service among the clinic patient population, participants in the ESoC + Text group who were unable to receive

Discussion

This study sought to demonstrate the feasibility and effectiveness of sending educational text messages, evaluating their impact on ED visit use among caregivers of infants. Historical clinic data reveals that on average, patients visit the ED 2 times before 13 months of age. While participants who only received ESoC information demonstrated similar ED use to our clinic's baseline ED utilization rate, participants who received text messages chose to go to the ED—overall and for nonurgent

Acknowledgments

This study was funded by the Department of Pediatrics, Saint Louis University School of Medicine, which had no influence in the design, data collection, analysis, interpretation of data, or construction and submission of this report. We thank the staff and care providers at Danis Pediatric Center at SSM Health Cardinal Glennon Children's Medical Center for their support.

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