title: Care by cell phone: text messaging for chronic disease management.
abstract: OBJECTIVE
  To assess the feasibility of engaging adults with diabetes in self management behaviors between clinic visits by using cell phone text messaging to provide blood sugar measurement prompts and appointment reminders.
  
  
  METHODS
  Quasi-experimental pilot among adult diabetic patients with cell phones who receive regular care at a federally qualified community health center in Denver, Colorado, which serves a population that is predominantly either uninsured (41%) or on Medicaid or Medicare (56%).
  
  
  METHODS
  Patients (N = 47) received text message prompts over a 3-month period. Blood sugar readings were requested 3 times per week (Monday, Wednesday, and Friday). Reminders were sent 7, 3, and 1 day(s) before each scheduled appointment. Acknowledgments were returned for all patient-sent messages. Focus groups were conducted in English and Spanish with selected patients (n = 8).
  
  
  RESULTS
  Patients of all ages were active participants. Correctly formatted responses were received for 67.3% of 1585 prompts. More than three-fourths (79%) of the cohort responded to more than 50% of their prompts. The appointment analysis was underpowered to detect significant changes in attendance. Participants reported increased social support, feelings that the program "made them accountable," and increased awareness of health information. Two-thirds (66%) of patients provided glucose readings when prompted during the study, compared with 12% at 2 preceding clinic visits.
  
  
  CONCLUSIONS
  For certain patients, cell phone-based text messaging may enhance chronic disease management support and patient-provider communications beyond the clinic setting.
authors.affiliation: Denver Health and Hospital Authority, Denver, CO 80204-4507, USA. henry.fischer@dhha.org
authors.forename: Henry H
authors.initials: HH
authors.lastname: Fischer
authors.forename: Susan L
authors.initials: SL
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Ginosar
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Davidson
authors.forename: Cecilia M
authors.initials: CM
authors.lastname: Rice-Peterson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Durfee
authors.forename: Thomas D
authors.initials: TD
authors.lastname: MacKenzie
authors.forename: Raymond O
authors.initials: RO
authors.lastname: Estacio
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Steele
mesh_terms: D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003120:Colorado; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011203:Poverty; D017010:Reminder Systems / Q000706:statistics & numerical data; D012648:Self Care / Q000379:methods* / Q000706:statistics & numerical data; D060145:Text Messaging / Q000706:statistics & numerical data*