Program evaluation of a mobile phone based intervention to improve patient follow-up after hospital discharge in Quito, Ecuador

In Ecuador, mobile phone penetration is estimated at 88% and growing. Although mobile phone-based health interventions are rapidly being implemented, few studies exist to demonstrate their efficacy for improved outcomes after hospitalization. Ecuadorian health professionals identify lack of follow-up after hospital discharge as an obstacle to effective care. With Ecuadorian partners, we developed a mobile phone-based program to facilitate follow-up after hospital discharge.

Method A consecutive cohort of adult patients admitted to a large public hospital in Quito over a one-month period was targeted for enrollment. A nurse stationed at the hospital attended all patient discharges, noted discharge instructions and relayed instructions to a nurse stationed in the community health center, who facilitated follow-up. Patients were asked contact the nurse via text message within 24 hours of discharge to relay health status and contact the nurse any time thereafter with questions or concerns. All contacts and counseling between nurse and patient were recorded.

Results 89% of eligible patients agreed to participate (N=35). 97% engaged in at least one contact with the nurse; 81% spontaneously initiated contact. The community-based nurse completed 267 patient contacts (12% text messages, 88% phone calls), clarified discharge and medication instructions, gave preventive education and facilitated patient appointments. 87% of patients attended scheduled follow-up appointments.

Conclusion The mobile phone messaging program was both acceptable and feasible for facilitating post-hospitalization follow-up care. Patients actively used cell phones to participate in their own health care. Ongoing studies will determine the suitability of a program for scale-up in Ecuador.