Engagement With Automated Patient Monitoring and Self-Management Support Calls

Abstract

Background Patient self-care support via Interactive Voice Response (IVR) can improve disease management. However little is known about the factors affecting program engagement. Methods We compiled data on IVR program engagement for 1,173 patients with: heart failure, depression, diabetes, and cancer who were followed for 28,962 person-weeks. Patients in programs for diabetes or depression (N=727) had the option of participating along with an informal caregiver who received electronic feedback based on the patient’s IVR assessments. Analyses focused on factors associated with completing weekly IVR calls. Results Patients were on average 61 years old, 37% had at most a high school education, and 48% reported incomes < $30,000. Among patients given the option of participating with an informal caregiver, 65% chose to do so. Patients completed 83% of attempted IVR assessments, with rates higher for heart failure (90%) and cancer programs (90%) than for the diabetes (81%) or depression programs (71%) (p<0.001). Among patients in diabetes or depression programs, those opting to have feedback provided to an informal caregiver were more likely to complete assessments (adjusted odds ratio: 1.36; 95% CI: 1.06, 1.75). Older patients had higher call completion rates, even among patients > 75 years of age. Missed clinic appointments, prior hospitalizations, depression program participation, and poorer mental health were associated with lower completion rates. Conclusions Patients with a variety of chronic conditions will complete IVR self-care support calls regularly. Risk factors for missed IVR calls overlap with those for missed appointments. Involvement of informal caregivers may significantly increase engagement.

Integrating Support Persons into Diabetes Telemonitoring to Improve Self-Management and Medication Adherence

“…22 While patients may have been reluctant to admit difficulties if they were uncomfortable with the automated interface of the IVR calls, IVR-obtained health data are at least as reliable as those obtained using structured interview or review of medical records. 7,32 Notwithstanding this fact, follow-up studies should include additional data sources, such as electronic event monitoring, medication refills, or bioassays, in order to validate impacts on patient adherence. A third significant issue was the limited sample size, which may have adversely affected our sensitivity to other effects.…”

“…4 Automated telemonitoring may help address these systemlevel limiters of effective diabetes self-management support. [5][6][7] We have developed an automated telemonitoring service for diabetes (the "CarePartner Program") that uses interactive voice response (IVR) telemonitoring, in which patients respond to prerecorded queries using their telephone keypad. Based on patients' IVR responses, the system provides tailored selfmanagement messages and notifies the patient's clinical team about health and self-management problems that may require additional follow-up.…”

Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression

“…We have established that the program has a high rate of engagement, yields valid and reliable clinical information, generates a manageable number of clinician notifications, and responds appropriately to urgent situations when implemented for depression 6 as well as for four other chronic conditions. 11 However, we are unaware of any other telephonic programs incorporating a support person. Therefore, this study tests the hypothesis that patients who choose to include a support person in their mHealth program show better improvement in adherence, symptoms, and function than those who participate in the same program without a support person.…”

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country

“…Although IVR call completion rates in the United States are typically greater than 85%, 17 patients with diabetes and hypertension in Latin America complete IVR calls at lower rates, especially when they are over 60 years of age. 18,19 Informal caregivers play a crucial role in supporting diabetes self-management 20,21 and may increase engagement in mhealth interventions.…”

“…Some IVR-based programs in the United States allow patients to participate with an informal caregiver (''CarePartner'') who receives automated feedback based on the patient's IVR assessments. Caregiver feedback has been associated with increased IVR engagement among patients with diabetes or depression 17,22 and may improve patients' health and self-care. [23][24][25] More generally, patients with an active and involved informal caregiver often have better self-management practices and health outcomes than patients who manage their chronic disease in isolation.…”