Examining the Impact of Providing Smartphones to Patients from a Managed Care Perspective: A Systematic Review

Objective: The objective of this study was to explore the literature within the last decade with respect to health plan purchase of smartphones for patients to improve health outcomes. A secondary objective was to explore smartphone use and cost. Methods: A systematic review using Pubmed, Medline, Cinahl Plus, Cochrane Library, Scopus, Trip and PsychInfo databases to identify studies regarding smartphone use conducted between 2005-2015. Key search terms included “mhealth”, “telehealth”, “smartphone”, “mobile applications”, “cost savings”, and “patient health outcomes”. Abstracts were screened against inclusion criteria and selected based upon relevance and quality. The most significant eligibility criteria required was that a smartphone must have been provided to the patient. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Use of Covidence facilitated the summary of selected articles. Notable characteristics were summarized in tables. Results The search yielded a total of 130 articles for review. Several examples within managed care were identified and focused on three key areas: disease and medication management, personal fitness and wellness and remote patient monitoring. Studies included managing these chronic diseases: Cardiac rehabilitation, COPD, Diabetes, HIV, Hypertension, Heart failure, rheumatoid arthritis, Addiction, chronic pain, and mental health diseases. Seven of ten studies related to disease management showed improvement in clinical outcomes measured. Studies in which smartphones were provided to remotely monitor patient data had the most impact in reducing hospitalization and emergency room visits. The Smartphones programs that featured mobile coaching and medication reminders had high levels of patient satisfaction and reported increased behavior change and medication adherence. Challenges reported of providing smartphones included ease of use and signal interruption. None of the studies identified thoroughly examined the costs associated with provision of smartphone to patients. Health plans must consider type of phone, additional training, cost of security and integration into healthcare models. Conclusion While smartphone use is growing, 48% of smartphone users had to cancel their cell phone service for a period due to financial hardship. The purchase of smartphones by health plans may mitigate these issues while improving health outcomes.