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Text messaging was the overwhelming preference over phone calling for one surgeon's hernia patients, a small study indicated.

Among patients agreeing to use a smartphone app for secure text communication, three-quarters of those responding to a subsequent survey said they thought care was improved over their previous experience with phone communication, according to Kevin Benavente, DO, of the University of Hawaii in Honolulu.

All but three of the 90 patients completing the survey indicated that the text system was at least non-inferior to calling, Benavente reported at the Society of American Gastrointestinal and Endoscopic Surgeons annual meeting.

About 86% of respondents went so far as to say they "preferred the texting application as their primary mode of communication with their physician," in place of phone calls, Benavente said.

Fourteen of the 90 patients said they had considered going to the emergency department (ED) because of symptoms; among these, eight said communication with their doctor via the texting app led them not to seek emergency care.

Perhaps most interesting, the strong preference for texting was seen across all age groups, including those 60 and older, who made up nearly 40% of the sample.

This finding "challenges conventional notions that modern technological innovations may be too complicated or inaccessible to this population of patients," Benavente's group suggested in the presentation abstract.

But he cautioned that the study came with important limitations -- the survey response rate was low (just over 30%) and, by design, only patients with smartphone access were able to use the app and thus were the only ones contacted for their opinions.

As a result, the findings are only "hypothesis-generating" and should be followed up with a more rigorous trial that examines "hard outcomes" such as complications, pain control, and revision procedures, he said.

Benavente also agreed with an audience member who pointed out that not everyone has access to text messaging, let alone smartphones capable of dedicated, secure texting apps. At the same time, however, "in this population that we studied, it seemed to be fairly common for patients to have access to smartphones and smart apps. That's something that I think really needs further investigation."

For physicians who might worry that such an app might increase their burden, Benavente offered some reassurance. He said the physician whose practice was the project's focus had indicated that it "actually ended up saving him some time compared with his past experience"; the physician could respond quickly to messages that he felt needed an answer from him, and he could refer others to support staff.

Study Background

Benavente prefaced his talk with observations about the traditional approach to patient-physician communication outside the office, which for a century has depended on the telephone. Patients may be frustrated by their inability to get their doctor on the phone immediately and often resent having a nurse respond to their concerns and requests. The result, he said, is often less compliance with the advice given and increased numbers of repeat calls.

Physicians aren't much happier with the phone, Benavente said. He cited an earlier study from pediatric practices about their experiences with phone calls, in which physicians made comments such as, "Any call would be too many" and "My families have no respect for my time."

As well, nurses doing phone triage typically "err on the side of caution," he said, sending patients to the ED for problems that did not genuinely need immediate care.

In 2017, study co-author Paul Szotek, MD, of the Indiana Hernia Center in suburban Indianapolis, began offering smartphone-owning patients use of a texting to communicate with him. This app is specifically designed for physician practices and is marketed as HIPAA-compliant.

For the survey study, Benavente (at the time, a student at Marian University College of Osteopathic Medicine in Indianapolis) and colleagues sent a short questionnaire to all of Szotek's patients who used the app during 2017 to 2020, a total of 277. It asked their age, whether the app improved or hindered their quality of care, whether use of the app reassured them that they need not seek emergency treatment, and whether they preferred the app or traditional phone calling for physician communication. The 90 patients included in the analysis were those who answered the survey fully.

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