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Survey: Underserved Populations Struggle with Patient Engagement, mHealth Adoption

May 18, 2015
by Rajiv Leventhal
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Urban and rural community health centers and clinics report that patient engagement has been challenging, particularly in areas related to the adoption of healthy behaviors and compliance with standard care recommendation and treatment protocols, according to a new survey by The Commonwealth Fund.

The survey included 181 urban and rural community health centers and clinics throughout 2013, asking them mainly about their current use of and experiences with the implementation of mobile health solutions. Most respondents (86 percent) report that patient engagement has been challenging. When asked in which areas organizations would like to more effectively engage patients, the greatest number of respondents (89 percent) said chronic disease management.

Further, using cell phones as a tool for patient engagement remains at an early stage of deployment across the safety net, with just more than one-quarter (27 percent) of respondents reporting they use cell phones in care delivery. Of the centers or clinics that do use cell phones in care, the most common application is to provide patients with appointment reminders (66 percent). Interventions to support chronic disease management, medication adherence, and smoking cessation remain at low levels, but organizations indicate they are planning to significantly increase their use within the next year.

Of the 173 organizations that identified three leading barriers to implementing cell phone interventions, 94 cited a lack of external funding sources and 91 said limited human and technical resources. The next-most significant barrier (65 respondents) was the integration of mobile health solutions with electronic health records (EHRs) and other health information technology infrastructure

Regarding organizations’ strategies for developing mobile health interventions, most have relied on their EHR platforms and the ability of those platforms to support text-messaging applications (62 percent of 42 respondents). A smaller number of organizations have collaborated with other health service organizations to co-develop interventions (10 respondents), contracted with mobile health solution providers (9 respondents), or developed proprietary technical or content elements (9 respondents).

The report concluded, “In addition to improving patient engagement, mobile health solutions can support critical components of health reform, like patient-centered medical homes and accountable care organizations. There is limited evidence, however, of effectiveness in improving health-related outcomes with underserved populations and insufficient case studies that illustrate best practices or effective strategies for the deployment of interventions. Moreover, there are few financial and technical resources that can support implementation. Such limitations constrain organizations’ abilities to realize the potential of digital health solutions.”

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