Value Seen in Diverse Digital Engagement Strategy

Black and underserved populations would rather use the telephone than an mHealth app in a remote patient monitoring program, according to researchers

A new study finds that Black and underserved populations would prefer to use the telephone to connect with care providers in a remote patient monitoring program.

The research by BJC HealthCare and the Washington University School of Medicine’s Healthcare Innovation Lab underscores the value of multiple, even personalized, communication channels between patients and health systems, and the challenges of finding a reliable way of engaging with populations dealing with the social determinants of health.

That will be important as more and more healthcare organizations launch RPM programs to monitor patients at home, particularly as they seek to improve outcomes in areas such as chronic care management, post-discharge care and behavioral healthcare.

Led by Bradley A. Fritz, MD, MSc, a member of the St. Louis-based health system’s Department of Anesthesiology, the research team tracked roughly 7,600 participants in a RPM program for COVID-19 treatment. They found that Black enrollees preferred using the telephone over an mHealth app by a margin of 68% to 44%, as did those from less disadvantaged neighborhood vs. those in better-off areas (59% to 43%). Conversely, retention rates were about the same between Black and white populations.

“Although we do not know what would have happened if the telephone arm had been unavailable, its presence appears to have bridged an engagement gap for Black patients,” the researchers said in a study published online by Springer. “Failure to bridge this gap might have worsened disparities between Black patients and other patients that already exist due to structural injustices (e.g., housing discrimination, limited public transportation) that limit access to primary care, nutritious food, and exercise.”

“We did not ask patients why they chose one program arm over the other, so we do not know if limited access to smart devices, limited internet connectivity, data privacy concerns, or other factors impacted their choices,” they added. “Distrust in healthcare organizations that have mistreated Black patients in the past may contribute to the engagement gap.”

“Our findings suggest that home monitoring programs may need to offer non-app-based options for participation to ensure they reach all groups of patients,” Fritz and his colleagues concluded.

The researchers also wondered whether the social isolation brought about by the pandemic played a part in the choice of communication platforms. They noted that several participants listed the ability to talk to someone on the phone as the best part of their experience.

The study points to the importance of planning an RPM program that encourages patient engagement, especially if it targets underserved populations or addresses barriers to accessing care. A program won’t work if it doesn’t pay attention to the patient.