Rapid Distribution of Complex Patient Information by SMS-Embedded Video Link During a Pandemic: Patient Uptake, Self-Risk Assessment and Feedback

Abstract

Background: Public Health England, national specialist societies and other regulatory agencies issued complex risk-based advice for rheumatology patients during the COVID-19 pandemic. Physicians were asked to risk-stratify their patients as low, medium or high-risk, applying over 40 variables. Urgent communication of targeted detailed information to at-risk patient groups has always been a challenge but novel technologies now allow video links and interactive resources to be distributed by SMS messages. We report a rapid intervention using SMS linked video in a large secondary care rheumatology service in the UK. Methods: We produced a patient video presentation to communicate information about rheumatology therapies, adjunctive treatments, and complex government self-isolation rules; authored a 4-step risk score, adapting complex physician-scoring so patients could self-identify if they were high-risk (day 0). Updated iterations encompassing changing national guidance were developed and piloted amongst peers and patients (day 1-3). We developed a web-based patient evaluation, using Likert scales to collect information on user metrics and the derived ‘risk-stratification score’. Our existing hospital SMS service distributed two SMS to our cohort of follow up patients (day 4): (1) explanation SMS and video link; (2) patient evaluation questionnaire. A limited subset (200) were asked to report age and gender. We collated video views and evaluations exactly 48 h (day 6) after initial distribution. Our pragmatic primary outcome measure was self-reported ability to risk-stratify. Findings: 12241 SMS messages were sent on day 4. By day 6, we recorded 5226 video views (42.6%) with 1167 patient evaluations (22.3% response rate). Patients reported successful self-risk stratifying 1105/1156 (95.6%), into low (237/1156, 20.5%) medium (544/1156, 47.1%) and high (324/1156, 28.0%) risk. Patient satisfaction scores (mean, median, SD) on 1-5 Likert scales (1: strongly disagree - 5: strongly agree) were: ability to risk-stratify themselves (4.3, 5, 0.95); educational value (4.3, 5, 0.96); ease of scoring (4.3, 5, 0.95); ease of playback (4.4, 5, 1.03); behavioural change (4.0, 4, 1.01), helpfulness of communication method (4.5, 5, 0.94). 1156/1167 (99.1%) patients returned risk stratification scores. Interpretation: This is the first study of its kind to communicate and evaluate sending an urgent complex public health message at large scale by SMS-video. Our results present striking acceptability and patient satisfaction scores. Its adoption offers a future paradigm shift in mass healthcare communication, and we urge national advisory bodies already using SMS messages to further consider its use. Funding Statement: No external Funding to declare. Declaration of Interests: No conflict of interest to declare. Ethics Approval Statement: Executive institutional approval confirmed that this service evaluation using anonymised data did not require formal ethics review. Additional consent is not required to send healthcare SMS messages under European Union General Data Protection Regulation (GDPR).