Even the simplest text messages can help patients get more out of their primary care visits, at least according to new research published in NEJM Evidence.
The study out of Ascension health system – “A Digital Care Plan Nudge to Improve Primary Care Outcomes” – spanned 76 primary care practices and 29,000+ patients.
- Patients were randomized to receive either usual care, or a digital nudge sent three days prior to their appointment.
- The nudges were a simple text message highlighting up to three preventative care needs to address during the visit, such as cancer screenings or vaccinations.
The results speak for themselves. The digital nudge group saw:
- An increase in appointment completions (+2.8 percentage points over usual care)
- A decrease in appointment cancellations (-1.5 percentage points)
- A decrease in appointment no-shows (-1.2 percentage points)
What about the care gaps? The digital nudge group addressed a care gap during 23.5% of visits, compared to 20.3% for usual care (P=0.08). In case anyone skipped stats class, that’s a bigger P value than we were going for, which basically means the jury’s still out on this one.
- On the bright side, digital nudges did show a statistically significant improvement to care gaps closed at 90 days (+5.4 percentage points over usual care), specifically for breast and colorectal cancer screenings, diabetes testing, and flu vaccines.
Although the study didn’t meet the primary outcome of addressing gaps on the day of the visit, digital nudges showed promise as a scalable way to improve outcomes over time by encouraging patients to be proactive with their health.
- Not a bad outcome considering that many patients arrive to primary care visits focused on immediate concerns, and springing new topics on them isn’t exactly a great way to inspire quick action.
The Takeaway
Patient activation works, and this study adds to the mountain of evidence supporting it. In the words of Ascension Chief Clinical Transformation Officer Mitesh Patel, “Most importantly, it reflects what’s possible when we combine behavioral science, digital tools, and a learning health system mindset.”
