Cardiac patients get help via text message
Program improves patient communication
As a way of prompting patients to attend more cardiac rehabilitation sessions, the University of Iowa Hospitals and Clinics in Iowa City has implemented a text message program that gives patients in the cardiac rehab program heart-healthy tips and reminds them of the sessions.
"We know that the more sessions a patient completes, the better the outcomes, but it's a challenge to keep the patients engaged in the program. We have found that few patients attend all 36 sessions, and many of them drop out too early," says Patricia Lounsbury, RN, BSN, Med, CCRN, FAACVPR, immediate past program director for cardiac rehabilitation, known as CHAMPS (Cardiovascular Health, Assessment, Management, and Prevention Services) at the University of Iowa Hospitals and Clinics.
The organization offers patients who have been hospitalized for heart attacks, coronary bypass or heart valve surgery, or heart disease up to 36 sessions of rehabilitation after they are discharged from the hospital.
Patients who are in the texting program complete significantly more sessions than patients who are not in the program, even if they don't complete all 36 sessions, Lounsbury says.
"Cardiac rehabilitation is as good as other cardiac treatments, including medication, in preventing patients from having another cardiac event. We want to get patients engaged in the program so they will complete as many sessions as possible," she says.
The cardiac rehab staff offers the program to all patients during their first visit and signs up those who have text messaging capabilities on their phone and who want to participate. Most of the patients who sign up are under age 70, Lounsbury says.
The clinic contracts with a technology company that provides three to five interactive text messages to participants each week. The messages are a combination of heart healthy tips and requests for information, such as, "How many minutes did you exercise today?" or "What is your blood pressure today?" The patients text back their answers to a computer program that is accessible to CHAMPS staff members at any time.
One of the nurses in the cardiac rehabilitation clinic checks the text message replies in the morning and afternoon via laptop computer. If any of the responses indicate the patient is having problems, the nurse either intervenes or alerts someone else on the staff.
In addition, the vendor takes patient answers to questions such as weight, blood pressure, and time spent exercising, and turns them into a graph that shows patient progress, which can be shared with the patient during the cardiac rehab session.
"We can show patients their weight loss or how their exercise has increased or blood pressure has decreased. This is a real motivator, and it helps them stay responsible for their own care," she says.
An added benefit to the texting program is that it allows the cardiac rehab staff to be in touch with patients between weekly sessions, Lounsbury says. For instance, one question is, "Did you take your medication today?" If a patient texts "no," someone in the clinic texts them back and asks if the doctor told them to stop and, based on the patient's answer, may intervene.
"Medication adherence is a big factor in managing this population of patients. We have contacted patients' physicians when they weren't taking their medication. In one case, when a patient said he couldn't afford his medication, we were able to get social services to help him connect with medication assistance," she says.
Another benefit to the texting program is that patients often text the clinic to say they won't make it to the next session.
"In the past, some patients were just no-shows. Texting is an easy way for them to let us know not to expect them. We text them back and ask them when we will see them again," Lounsbury says. When patients don't contact the clinic and don't reply to the texts for a while, the clinic staff send them a text message asking if they want to stay with the program, she says.
Once patients are in the program, they can continue to receive text messages as long as they like, or they can drop it when they finish cardiac rehab, she says. n