‘From the ED2PMD’: A Text Messaging Program to Connect Adolescents to a Health Home

Abstract

Adolescents are frequent users of the ED often for non-urgent complaints. Those attending the ED frequently lack a medical home. Increased access to primary care for non-urgent complaints can decrease use of the ED. Proximity to an ED and inability to obtain a clinic appointment contribute to adolescents’ use of the ED and highlight the need for cost effective transition to a medical home. Adolescents report favorable attitudes towards communicating via texting with healthcare providers. Texting is a cost-effective means of increasing outpatient attendance and communicating with high-risk patients, but has not been studied in transitioning adolescents from the ED to primary care. We hypothesize that connecting adolescents to a “health home” will encourage fewer subsequent visits to the ED for primary care needs. To evaluate the effect of text messaging on encouraging primary care follow-up at an adolescent health center (MSAHC), for adolescents who sought care at an emergency department (ED). The study took place at Mount Sinai Pediatric Emergency Department (ED) in New York City from November 2012 to March 2013. Male and female patients, ages 15-22 years, attending the ED were asked to indicate their interest in receiving text messages from the ED on the initial registration form. Patients who requested text messages provided their cell number, service provider, and preferred language (English/Spanish). Enrolled cell numbers were entered into a text messaging platform within twenty-four hours of attendance at the ED. They received a series of automated text messages encouraging appropriate primary care follow-up at an adolescent health center. Patients received two messages per week for four weeks, including health center information, hours and location. Mount Sinai Adolescent Health Center (MSAHC) is a non-profit clinic providing free primary care for uninsured adolescents, located within walking distance of the Mount Sinai ED. Demographics and diagnosis were abstracted from the electronic medical record (age, race and ethnicity, home address zip code, diagnosis, health insurance status). Previous attendance and follow-up at MSAHC within 10 weeks of their ED visit was documented. There were 2440 patients, ages 15-22 years, enrolled in the study. Thirty-eight (38%) percent consented to receive texts. Preliminary analysis using a chi-square test revealed a significant relationship between receipt of texts and follow-up at the MSAHC within 10 weeks of the ED visit. X2 (1, N=2440) = 3.88, p=0.049. Forty-six percent of adolescents who received text messages followed up at the AHC within 10 weeks of their first ED visit. Follow-up at MSAHC beyond 10 weeks of the ED visit was also significant. X2 (1, N=2240) = 4.5, p=0.033. Sixty-two (62%) percent of adolescents who did not follow-up did not receive text messages. Text messaging is a feasible and effective tool for increasing outpatient follow-up after an ED visit at a primary care facility, potentially relieving an additional burden on the ED and promoting health care in the transition to adult medicine. Establishing a connection with a primary care provider will enable adolescents to have a better and more comprehensive health care that is otherwise absent for much of the ED-frequenting population.