Clinical trial NCT03034993: Self-Management Using Text Messaging in a Homeless Population
Official title: Improving Self-Management of Chronic Conditions Among Homeless Persons: a Community-Based Participatory Approach Using Text Messaging
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Chronic Disease
Keywords: Healthcare for homeless
Text messages
Primary care visits
Medication adherence
Inpatient admissions
Lead sponsor: Boston University
Sponsor class: OTHER
Collaborators: name: Boston Health Care for the Homeless Program
First posted: 2017-01-27
Enrollment: 64
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is to determine if an automated text message intervention is beneficial for homeless patients in reducing their hospital visits, increasing their primary care appointments, and help them increase medication adherence.

Detailed description: Boston Healthcare for the Homeless Program (BHCHP) is the study site for this research. It is the largest freestanding health care for the homeless program in the country - it provides primary care, behavioral health, oral health care and other wrap-around services to 12,500 homeless individuals a year. BHCHP was recently awarded a two-year grant from the Massachusetts Health Policy Commission to demonstrate how intensive, coordinated case management can reduce costs of caring for homeless persons who are high utilizers of emergency department (ED) and inpatient care. The Social Determinants of Health Coordinated Care Hub for Homeless Adults project (hereafter the "Care Hub") will create capacity among 9 Boston organizations serving homeless residents to meet their needs in primary care, behavioral health, housing, and shelter. This will improve quality of life, health outcomes, and care efficiency for the organizations. The participating organizations, in addition to BHCHP, are Bay Cove Human Services, Boston Public Health Commission, Boston Rescue Mission, Casa Esperanza, Massachusetts Housing and Shelter Alliance, The New England Center and Home for Veterans, St. Francis House, Victory Programs Specifically the investigators anticipate that patients participating in the Care Hub will have reduced use of ED and inpatient care because they will be better linked to and retained in appropriate care such as outpatient, mental health, substance use disorder (SUD), preventive care, and respite care. Regular care will increase the appropriate management of chronic health conditions and reduce episodes of exacerbations of these conditions which often lead to ED and hospital care. The purpose of this study is to evaluate whether an a text messaging system of appointment reminders, along with medication taking messages, and text messages about mood will augment the effectiveness of the Care Hub program.

The investigators propose to pilot a cell phone-based outpatient care support and medication reminder system. The content will include appointment reminders and educational and motivational messages about the importance of going to all outpatient care visits and of taking medications. The investigators take a community-based participatory research approach to this study - both because it appropriately considers the needs of the target population (increasing the likelihood of success) and because it empowers a population that is often treated as if its members were powerless. The cell phone texting intervention will help patients stay engaged in care, adhere to their medications, and adopt and sustain behavior change. This will be accomplished by completing a series of objectives:

1. To develop a text messaging system designed for homeless patients which includes appointment reminders, medication taking reminders and motivation, and texts messages that allow participants to report their mood, all in support of chronic disease management. The system will be based on a health coaching model, and message content will be reviewed and edited by patients who are members of drafted by patient members of a BHCHP Community Innovation Panel (CIP).
2. To train Care Hub intervention patients (or refresh existing skills) in cell phone text messaging.
3. To test the text messaging system in a randomized pilot study with 60 patients, comparing outpatient, respite care, ED, and inpatient utilization, and Health-Related Quality of Care (HRQOL) between the 30 intervention and 30 control patients.

Eligibility criteria: Inclusion Criteria:

* is a patient participant in the Coordinated Care Hub Initiative
* is willing to receive text messages
* is able to understand English - spoken and read

Exclusion Criteria:

* has an inability to find, open, and respond to a test text message

Primary outcomes:
measure: Emergency Department Visits Made
timeFrame: 4 months
Secondary outcomes:
measure: Inpatient admissions
timeFrame: 4 months
measure: Appointment keeping
timeFrame: 4 months
measure: Medication Adherence
timeFrame: 4 months
measure: Adult Well-Being Assessment
timeFrame: 4 months
measure: Comfort with Computers and Cell Phones
timeFrame: 4 months
measure: Frequency of Cell Phone Use and Computer Use
timeFrame: 4 months
measure: Outpatient appointments
timeFrame: 4 months
Other outcomes:
Locations:
city: Boston
country: United States
facility: Boston University School of Public Health
state: Massachusetts
Study officials:
affiliation: Boston University and Department of Veterans Affairs
name: Donald K McInnes, ScD
role: PRINCIPAL_INVESTIGATOR
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