Coded Text Messaging to STD Clients: A Step in the Right Direction

1. Coded Text Messaging to STD Clients:A Step in the Right Direction Randall B. McClallen, RN, BSN Peoria City/County Health Department

2. Introduction • Treatment after the diagnosis of an STD at the Peoria City/County Health Department Sexually Transmitted Disease (STD) Clinic took clients an average of 14 days to receive their medication

3. Introduction(continued) • Procedures for clients to receive their STD results have remained unchanged for more than 10 years • It was observed the majority of our clients carried cell phones

4. Objective • To decrease the length of time from diagnosis to treatment • To implement a system that is cost effective and efficient • To be appealing for client buy-in

5. Methods • Email account (qpublic@peoriacounty.org) set up with IT Services on Health Department Microsoft Office Outlook • Coded text message developed to protect privacy • Data was collected from 12/1/2008 – 5/30/2009 and 9/1/2009 – 12/31/2009

6. Methods(continued) • Data was collected only on clients with a positive gonorrhea or chlamydia result • There were a total of 3 clients lost to follow-up and not counted in result findings: • Total number of clients screened: 2290 • Total number of clients with positive STD result: 382

7. Client Instruction Card

8. Sample Coded Text Message

9. Results: Treatment

10. Results: Gender

11. Results: Race

12. Results: Flow Chart

13. Results(continued) Average Time (days) for Patients Requiring Follow-Up Treatment and T-Test

14. Conclusions • Sending a coded text message to clients that need treatment is more cost effective • Estimated salary cost for clerical person to send a text message is 19¢ per text • Estimated salary cost for PHN to spend 2 hours to bring a client in for treatment is $48.68

15. Conclusions(continued) Cost Analysis for Required Follow-Up Treatment A Assumption that for each patient, the average time for nurses to follow-up was 1 hour per case. B Estimated salary includes benefit time. C Costs associated with communication using traditionalmethods are included in the health department’s overall cost of operations. D Only one text message was sent to each participantwith the group.

16. Conclusions(continued) • Effectively reaches a transient population • Client buy-in evenly received: • Text Clients: African-American: Male n=95, 54%; Female n=25, 14%Caucasian: Male n=30, 17%; Female n=25, 14% • Call Back Clients: African-American: Male n=124, 60%; Female n=55, 26%Caucasian: Male n=18, 8%; Female n=13, 6%

17. Program Implications • Public Health agencies should implement services that will be receptive to at-risk populations • Text messaging STD results can save money and time • Further study should be done to see difference in partner treatment

18. Responses from Inquiries “ We have not yet been able to implement it for our general clinic population but we are about to start some pilots with our patients participating in research projects in an attempt to expedite the delivery of negative results. I am definitely interested in the project and hope that in the next 2-9 months I can overcome the red tape at our health department to pilot the project in our busiest clinic.”

19. Responses from Inquiries “ I just received a small grant from a local foundation to do a trial of a text messaging intervention with girls who are on Depo-Provera and am trying to gear up to get it going. We chose Depo instead of STIs because of the patient volume and we are primarily looking at improving attendance to clinic appointments for a stable group of sexually active girls.”

20. Responses from Inquiries “ We actually have not implemented text messaging in our clinics yet because the protocol I drew up required that we collect cell phone carrier on the medical record, which was a new field. We are currently very short staffed in our Department in the IT division and there is no one available to add that field to the electronic medical record. Once we make the necessary updates to the MR, then we will begin using it to contact patients who need to return to the clinic for treatment.”