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In part two of the Diabetes Prevention, Care, and Education in the Digital Age series, Athena Philis-Tsimikas, MD, discusses how Project Dulce, a diabetes care and education program, is using digital tools, including text messaging, to address the specific needs of culturally diverse populations.

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Transcript:

DR. PHILIS-TSIMIKAS: There have definitely been lots of apps that have been promoted out there for health and one of my skepticisms is that – have these actually been looked at? Do they make a difference for our patients today when we recommend them?

We have a high population of Latino patients in our community. And one of the things we found was that many of them use mobile phones. As a matter of fact, probably much more than they have access to computers in their home.

Project Dulce was a program that we created 21 years ago where we tried to integrate, and we did integrate, nurse care management together with peer-led education into the Latino community to try and improve care, and also work side-by-side with primary care physicians to help them ease the burden of taking care of a chronic illness.

And we thought texting would be the best approach. We translated our curriculum into 160 messages approximately. Each message could not have more than 140 to 160 characters as a text.

There were educational, motivational, and reminder messages that came through. So things like, “Tick-tock, it's time to take your medication.” Very simple, short messages. And those were sent out 2 to 3 times a day over a six-month time period. There was a one percent decrease in hemoglobin A1C between the intervention group and the usual care group.

They liked the simplicity. They liked the ease. It was very low cost and they liked the reminders. They felt like someone was thinking about them and their diabetes and helping them to manage it.

Digital tools and technology can really take on a very broad range when you think about it.

Texting is one method that we used. It can be everything from the EMR [Electronic Medical Record] – and being able to communicate via the EMR and the portal with a patient directly and securely – to digital retinal scans. You can send, wirelessly, glucose measurements to a cloud and then have that feedback – reports to a care manager or to a physician. And then being able to manage that patient remotely rather than with a direct visit in your environment and in your clinic.

This can be good for people that have transportation issues, other difficulties, child care, or work that interferes with them coming in for medical care.

Some of the difficulties that we’ve found with patients include things like, ¬is there a telephone compatible with what you need for that app? We're finding that every time a change is made in the app, if your phone isn’t compatible, you can't upload it, you can't use it. Is the app itself simple enough for someone to understand what they need to do? There's a lot of steps involved in communication with apps and every time you make that step a little bit more complex, it's a disincentive to that patient to be able to use it easily.

And even the reports – if a physician needs to look at the reports, if it's difficult for us to bring those reports up and be able to view them, then that's a barrier also. So, anything that can make those steps easier would be valuable.

For physicians, sometimes it's a little bit difficult to think of. Don't create that end product that you think is right. Start with something simple, and then allow it to progress with the needs of the population.