PHONE-CONNECT: a pilot of phone distribution for marginalized ED patients

The shift to telehealth during the COVID-19 pandemic worsened digital health disparities, particularly for people experiencing homelessness who lack access to mobile devices. This pilot evaluation was designed to assess the preliminary impact of a novel emergency department (ED)-based phone distribution program.

We conducted a mixed-methods observational pre-post-study evaluating the impact of a mobile phone distribution program at two urban EDs in Toronto, Canada, from November 2019 to May 2022. The quantitative component consisted of a retrospective cohort analysis of 309 patients, comparing healthcare utilization three months before and three months after phone distribution. The qualitative component involved 12 semi-structured interviews exploring participant experiences. The primary outcome was attendance at scheduled specialist appointments and the secondary outcome was ED utilization.

Among the 309 participants, 67.6% were unhoused, and 50.8% had chronic health conditions. There was no significant change in the overall number of ED visits after phone distribution when comparing three months pre-intervention to three months post-intervention. However, the proportion of mental health-related ED visits significantly decreased post-intervention, while the proportion of visits for physical health concerns increased. Among those connected to intensive case management, no-show rates for appointments were significantly lower in the case management group compared to the non-case management group. Younger patients (≤ 44 years) had lower cancelation rates post-intervention. Qualitative findings of patient interviews revealed three benefits: improved health ownership, increased ability managing daily life and future planning, and strengthened social connections.

An ED-based phone distribution program may improve healthcare access and social inclusion among digitally excluded patients. Pairing phone distribution with case management can enhance impact. Increasing access to mobile phones should be considered in improving equitable access to healthcare.