Title: Moving Mobile Health Forward: Combining mHealth with Community Health Workers Bolsters Heart Failure Care
Abstract: Background Telemedicine programs targeted towards vulnerable HF patients have had high expense and variable impact. Mobile Health (mHealth) based HF management has been limited by lack of frequent communication between patients and the health care team and adoption of mHealth due to failure to address both medical and social needs common to underserved patients. Community health workers (CHW) have been successful in improving self-care and reducing readmissions in many chronic diseases, however, a combination of CHW and mHealth has not been investigated. Goal of this pilot study was to implement an innovative strategy for mHealth adoption, and effectiveness by integrating it with CHWs for the management of HF in an underserved population. Methods mHealth app was provided to HF pts. Based on initial mHeath use, patients were assigned to continued mHeallth or CHW + mHealth. CHW attempted regular phone or home contacts. mHealth activity was monitored on online platform. Outcomes included mHealth adoption, medication adherence, ED visits/Hospitalization and QOL. Results A total of 111 patients were screened and 24 patients were enrolled (16 systolic; 9 male, mean age 52). Overall, adoption of mHealth was low. Eighty-seven phone contacts and 1 home visit were made over 6 months. Despite a high rate of reported medication adherence at baseline majority of the patients felt that adding CHW to mhealth was useful and their HF was better managed being in the program. Conclusion In this pilot study, combination of CHW with mHealth failed to enhance mHealth adoption. Despite poor adoption, the combination resulted in improvements in self-reported medication adherence, QOL and reduced hospitalization. Future studies need to address factors related to poor adoption among underserved HF patients.