JMIR Publications

ABSTRACT

Background:

The rising cost of unscheduled acute healthcare, particularly for emergency department (ED) visits, poses significant financial burdens, especially for patients with diabetes, with US ED costs reaching $19.3 million in 2022.

Objective:

This study explores the impact of a mobile health (mHealth) intervention with augmented social support delivered via guided text messaging on healthcare utilization among diabetes patients through a secondary analysis of the TExT-MEDS + FANS randomized controlled trial.

Methods:

The trial involved 173 participants randomized into mHealth-augmented social support (FANS) and an active control group that received the same support curriculum via mailed pamphlet. In this context, “augmented” social support refers to traditional support that is structured and enhanced through mHealth text messaging designed to engage and guide supporters. Healthcare utilization outcomes–including ED visits, hospitalizations, and clinic visits–were compared between groups during and after the intervention period using linear regression models on change in healthcare visits in the last year, with subgroup analysis by participant gender and supporter relationship using interaction terms.

Results:

Results showed significant reductions in acute unscheduled care visits for both groups during and after the intervention, with the FANS group experiencing a reduction of 1.04 visits during the intervention and 1.10 visits post-intervention, while the control group had reductions of 1.47 and 1.53 visits, respectively. All these values are statistically significant (P<.001). Clinic visits increased by 1.78 (P=.012) during the intervention phase but did not sustain post-intervention, and hospitalizations modestly decreased in both groups, with a reduction of 0.24 visits in the active control group and 0.18 visits in the FANS group, with the former being statistically significant (P=.002). Gender and supporter relationship differences were observed, with females supported by spouses in the active control group showing the largest decrease in unscheduled care visits.

Conclusions:

The findings suggest that mHealth interventions combined with structured social support can effectively manage diabetes and reduce healthcare costs, particularly for groups with limited access to care. While these conclusions are based on the present study, they align with prior research demonstrating the benefits of social support and mHealth interventions in chronic disease management. These findings may inform future diabetes programs, including the design of low-cost, scalable interventions in resource-limited settings and the development of policies that support patient-supporter engagement tools.