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Texting and connecting in patients with dysautonomia of adolescence : a novel approach between patients and their health care providers

University of British Columbia

Rationale: Clinical digital messaging (CDM) (text messaging) improves communication and engagement between adolescent patients and their health care providers (HCP). Dysautonomia of Adolescence (DAOA) is a condition which results in transient dysfunction of the autonomic nervous system (ANS). Many adolescents who are affected withdraw from school, sport, recreational activities; experience social isolation; and have significant mental health challenges. Quality of life (QoL) is severely affected, symptoms are difficult to predict and control. Ongoing support by HCP is needed to support management of symptoms. We sought to implement CDM to support DAOA patients and evaluate patient engagement, satisfaction, QoL and symptom burden. Methods: A single-centre, 12-month intervention study was performed. CDM was supported by WelTel Inc. Participants received an automated weekly check-in text message asking “How are you?”. Responses were triaged by HCP. QoL and symptom data were collected at three 6-month intervals: T0 baseline, T1 CDM enrollment and T2 post-CDM intervention. Non-parametric Friedman tests were used to determine differences over time. Participant engagement with the CDM platform was assessed through response rate and number of care conversations (>2 text messages between participant and HCP). Participant satisfaction was assessed using surveys administered at T1 and T2. Frequency counts (%) were performed for categorical variables and a univariate analysis performed on continuous variables. Tests were two-sided and a p<0.05 was considered statistically significant. Results: There was an 80% recruitment rate. Twenty-six participants completed the study. Median (IQR) age of participants was 16.8 (15.7-17.4). Duration of CDM intervention was 33 weeks (26.8-37.3). A total of 896 automated weekly check-in messages were sent, resulting in 206 care conversations. Ninety-five percent of participants found CDM useful. There was no change in total QoL, number of frequent or occasional symptoms (p=0.260, 0.260 and 0.790, respectively). Conclusion: Twenty-three percent of all messages received from DAOA patients required care conversations. Participants were receptive to and satisfied with the CDM platform. Total QoL and symptom burden remained unchanged over the study period. CDM facilitated ongoing management of care in participants. Use of CDM technology may teach adolescents to advocate for themselves and become active participants in their own healthcare.

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2020-08-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/75744

Experimental Medicine

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/