Texting can be lower-cost tool for patient outreach

Automated text messages to patients could save money and staff time, compared to telephone calls, while expanding outreach to patients with limited email and Internet access, according to a study from the Perelman School of Medicine at the University of Pennsylvania.

Encouraging patients to get vaccinated against COVID-19, researchers had hypothesized that texting might reach more patients than telephone calls. They found text messages reached as many patients as telephone calls, with both methods having a response rate of about 3%.

“Text messaging offers a low-cost alternative to outbound telephone calls, but additional efforts are needed to increase vaccine uptake,” the study said.

“The take-away is that the text arms of our study were comparable to the phone-only arm, but the text messaging is less resource-intensive since a live call center only needs to talk to those who are already interested instead of making cold calls to everyone on the list,” lead author Shivan Mehta, MD, said in a news release.

The trial also found the response rate was higher among Black patients, those with lower incomes and Medicaid patients, compared to White, higher income and commercially insured patients. “I suspect this is because the latter groups responded more to earlier email/patient portal efforts,” said Mehta, an assistant professor of medicine and associate chief innovation officer at Penn Medicine.

The study involved 16,045 patients in the Philadelphia, Pennsylvania, area, April 29 to July 6, 2021. It was a time when the initial wave of enthusiasm for COVID-19 vaccines began to wane, so Penn Medicine aimed to read a wider population of patients and improve equity with telephone calls.

“This approach did address some equity concerns, but it was incredibly resource-intensive, and patients often didn’t answer the phone,” co-author Colleen Mallozzi, Penn Medicine associate clinical informatics officer, said in a news release.

The health system divided patients into three groups to schedule vaccine appointments. They received just phone calls from the health system; automated texts and follow-up phone calls; or only automated texts. Among the groups, patients who got their vaccines were 3.6%, 3.1% and 3.3%, respectively.

The lessons for patient outreach could be applied to other areas of health care, Mehta said.

“We are taking lessons learned and applying it to flu vaccines, breast cancer screening, and colorectal cancer screening,” Mehta said. “Phone and text messaging are useful tools to improve equity in response rates to preventive health outreach, particularly among minority and older patients. The efficiency of automated text messaging over cold calls that take a lot of staff’s time makes these efforts particularly promising.”