Improving linkage to care in an emergency department hepatitis C screening program with text messaging

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Conference Proceeding

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Academic Emergency Medicine


Background and Objectives: Effective hepatitis C (HCV) screening programs in EDs depend on reliable means to contact patients after discharge. Phone calls are the standard means of communication for these efforts, yet many patients are lost to follow up when they are unreachable by telephone. To increase rates of linkage to care for patients with positive HCV screening tests, we utilized text messaging as an adjunct to telephone calls.

Methods: Patients identified as lost to follow up with a positive HCV screening test from 8/2018 to 9/2020 in our opt-out ED HCV screening program were included in this study. A text message asking the patient or family member to call an ED physician regarding a test results was sent 11/2020 -1/ 2021 to phone numbers listed in the electronic medical record. The rate of linkage to care using text messaging was determined as of percentage of patients linked to care of all patients messaged.

Results: A total of 381 messages were sent for 153 patients that were lost to follow up with a median of 2 messages per patient. A response from either the patient or patient contact person(s) was received for 42 patients (27.5% of all patients messaged). More patient contact persons (27, 64.3%) responded to messages compared to patients themselves (15, 35.7%). A direct phone call response (30, 71.4%) to the text message was more common than a text message response (12, 28.6%). At the time of abstract submission, 13 patients previously lost to follow up were pending specialist appointment scheduling, 2 were scheduled for a future specialist appointment, 1 attended their first appointment, and 5 were pending a lab visit for RNA testing. The median time to the first scheduled specialist appointment from referral placement was 23 days. Of those originally lost to follow up from 8/2018 to 9/2020, upon re-establishing communication 6 patients reported being treated previously, 3 were currently being treated or evaluated, and 6 were deceased/ hospice. Overall, we re-established contact with 36 (23.5%) of the 153 total patients using text messaging.

Conclusion: Text messaging is a valuable adjunct to phone call-based result notification. Family members and contact persons are an especially useful resource to enhance connection to care for this patient population. Providers may consider the routine use of multiple methods of communication and contacting family members to connect patients to care following ED visits.




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