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OBJECTIVES

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Objectives

  • Describe the rationale for using interactive mobile health (mHealth) technologies as an adjunct to the care of socioeconomically vulnerable patients, both in the United States and abroad.

  • Review potential uses of mHealth in chronic illness care.

  • Review the evidence for the effectiveness of mHealth in chronic illness care.

  • Describe the characteristics of patients best suited to use mHealth as part of their care.

  • Review the use of mHealth as a method of improving communication between providers of health care (inpatient and outpatient; community and health system).

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Jason, a patient with active human immunodeficiency virus (HIV) and occasional cocaine use, has difficulty adhering to the multi-pill HIV regimen. He enrolls in a novel web-based program in which he is equipped with a text pager that reminds him when and how to take his medications and prompts him to enter simple adherence data. If he does not respond or reports poor adherence, his case manager attempts to connect with him either in person or by phone. Several months after enrollment in the program, his viral load drops to the undetectable level.

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Innovative methods to educate patients and providers, promote adherence, and enhance communication both between patients and providers and among providers across different settings have become available through the growth of computer-based technologies. Interactive web- or mobile phone-based programs are often broadly referred to as mobile health or “mHealth,” a term that we will use here to encompass any patient-facing computerized health technology. Examples of mHealth include systems that monitor patients’ progress toward physical activity goals, assess risk of disease, remind patients to take medications, or provide the information patients need for more informed decision making. While most patients with chronic diseases struggle with self-care, innovations such as these may have the greatest impact on improving the care of vulnerable patients, who often face barriers to accessing health information and support via face-to-face encounters with clinicians and other helpful social network members.

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Access to the Internet is becoming commonplace. Recent surveys by the Pew Research Center report that 85% of Americans use the Internet and 91% have mobile phones (including 56% who have smartphones with Internet access).1 Most importantly, the differences in Internet and mobile phone use by race/ethnicity and socioeconomic status have been shrinking rapidly. Similarly, there has been an explosion in the use of mHealth technology in health-care settings, such as the introduction of personal electronic health records for patients and the availability of thousands of mobile phone applications for managing a wide range of health and health-care topics. Even when examining the uptake of technology internationally, it is clear that the digital divide is shrinking between low- and high-income countries as well, with mobile phone coverage and use growing quickly worldwide. In fact, many of the lessons learned from implementing technology interventions in low- and middle-income countries are particularly informative for improving the health and health care of vulnerable patients ...

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