The Use of Interactive Voice Response Systems to Improve the Quality and Safety of Ambulatory Care

Foster, Alan J.

doi:10.4018/978-1-60566-356-2.ch017

Cited by 18 publications

(23 citation statements)

References 79 publications

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“…16,17,[69][70][71]73,77 Two reviews reported improved educational outcomes 11,73 and seven reported significant positive behavioural change, 11,17,20,68,71,73,75 particularly improved self-monitoring or management in patients with diabetes 17 and better treatment adherence. 17,20,68 There were few firm conclusions about the impact of telehealth on quality of life, although one meta-analysis reported improvements associated with computer-mediated support groups. 75 The three reviews which suggested that telehealth improved social support 11,73,75 were countered by three that reported inconsistent or insufficient evidence.…”

Section: Specific Outcomesmentioning

confidence: 99%

“…70 However, other reviews showed limited impact on service utilisation 11,76 and meta-analyses reported that the evidence for a positive impact of telehealth on resource utilisation was questionable. 11,68,77 Cost-effectiveness Four reviews found some evidence for cost savings, 20,70,74,77 but one was unable to determine cost-effectiveness. 11 547 excluded as duplicates, not telehealth, not LTC focused, not systematic reviews, service-to-service interventions, protocols or conference proceedings 36 full papers retrieved for full-text screen by two reviewers 11 excluded: did not report outcomes, not LTC specific, historical accounts, service-to-service interventions, diagnosis specific 16 high-quality systematic reviews included in meta-review 25 systematic reviews assessed…”

Section: Specific Outcomesmentioning

confidence: 99%

“…8,20,70,77 The use of mobile phones and text messaging appeared to be effective, 71,73 particularly for promoting behaviour change. Vital signs monitoring was reported as producing clinical benefits in approximately half of the trials in one review, 20 but other reviews suggested that this might be limited to particular conditions, such as hypertension, 69 diabetes, 17,68,69,77 heart failure 17,68 and respiratory conditions. 69 Vital signs monitoring was associated with increased mortality among COPD patients and appeared to offer no benefits for dementia, 70 obesity or blood glucose control in diabetes.…”

Section: Patient Satisfactionmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Specific Outcomesmentioning

confidence: 99%

Section: Specific Outcomesmentioning

confidence: 99%

Section: Patient Satisfactionmentioning

confidence: 99%

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An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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“…To address these gaps, we designed an intervention using interactive voice response technology 9–11 to facilitate the delivery of evidence-based tobacco cessation counseling and medication after hospital discharge. The goal was to create a low-cost translatable system requiring minimal health system personnel to implement.…”

Section: Introductionmentioning

confidence: 99%

Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults

Rigotti

Regan

Levy

et al. 2014

JAMA

129

117

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IMPORTANCE Health care systems need effective models to manage chronic diseases like tobacco dependence across transitions in care. Hospitalizations provide opportunities for smokers to quit, but research suggests that hospital-delivered interventions are effective only if treatment continues after discharge. OBJECTIVE To determine whether an intervention to sustain tobacco treatment after hospital discharge increases smoking cessation rates over standard care. DESIGN A randomized controlled trial conducted from August 2010-November 2012 compared Sustained Care, a post-discharge tobacco cessation intervention, vs. Standard Care among hospitalized adult smokers who received a tobacco dependence intervention in the hospital and wanted to quit smoking after discharge. SETTING Massachusetts General Hospital, Boston, MA. PARTICIPANTS 397 hospitalized daily smokers (mean age 53 years, 48% male, 81% nonhispanic white). 92% of eligible patients and 44% of screened patients enrolled. INTERVENTION Sustained Care participants received automated interactive voice response telephone calls and their choice of free FDA-approved cessation medication for 90 days. The automated calls promoted cessation, provided medication management, and triaged smokers for additional counseling. Standard Care patients received recommendations for post-discharge pharmacotherapy and counseling. MAIN OUTCOMES Biochemically-validated past 7-day tobacco abstinence 6 months after discharge (primary outcome); self-reported tobacco abstinence and smoking cessation treatment use at 1, 3, and 6 months. RESULTS Smokers assigned to Sustained Care (n=198) used more counseling and more pharmacotherapy at each follow-up than those assigned to Standard Care (n=199). Biochemically-validated 7-day tobacco abstinence at 6 months was higher with Sustained Care than Standard Care (26% vs. 15%; RR 1.71, 95% CI 1.14–2.56, p=0.009; NNT=9.4, 95% CI 6.4–35.5). Using multiple imputation for missing outcomes, the RR was 1.55 (95%CI 1.03–2.21, p=0.038). Sustained Care also produced higher self-reported continuous abstinence rates for 6 months after discharge (27% vs. 16%; RR 1.70, 95% CI 1.15–2.51, p=0.007). CONCLUSION Among hospitalized adult smokers who planned to quit smoking, a post-discharge intervention providing automated telephone calls and free medication resulted in higher rates of smoking cessation at 6 months compared with a standard recommendation to use counseling and medication after discharge. These findings, if replicated, suggest an approach to help achieve sustained smoking cessation after a hospital stay.

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“…IVRS calls are increasingly used for drug monitoring posthospital discharge6 and they were shown to lower the costs of delivery of routine test results by 33% in comparison with inperson calls,7 and to facilitate treatment adherence 8 9. The IVRS can send automated calls at specific times, such as after the new prescription.…”

Section: Background and Significancementioning

confidence: 99%

Usability of a computerised drug monitoring programme to detect adverse drug events and non-compliance in outpatient ambulatory care

2013

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The Use of Interactive Voice Response Systems to Improve the Quality and Safety of Ambulatory Care

Cited by 18 publications

References 79 publications

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Sustained Care Intervention and Postdischarge Smoking Cessation Among Hospitalized Adults

Usability of a computerised drug monitoring programme to detect adverse drug events and non-compliance in outpatient ambulatory care

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