Alongside increasing efforts to deliver health care remotely, there is a need for research to assess the effects of these new approaches. In a new Cochrane Review from December 2016, Pawel Posadzki from the Lee Kong Chian School of Medicine in Singapore, and colleagues bring together the evidence on automated telephone communication systems. We asked Pawel to tell us what they found.
John: Alongside increasing efforts to deliver health care remotely, there is a need for research to assess the effects of these new approaches. In a new Cochrane Review from December 2016, Pawel Posadzki from the Lee Kong Chian School of Medicine in Singapore, and colleagues bring together the evidence on automated telephone communication systems. We asked Pawel to tell us what they found.
Pawel: Automated telephone communication systems, or ATCS, send voice messages and collect health information from people using their telephone’s touch-tone keypad or voice-recognition software. They might have a number of advantages over traditional face-to-face consultations, including convenience, accessibility, ease of use, immediacy of feedback to the healthcare consumer, anonymity and low cost; and we did this review to assess their effectiveness. We wanted to see the effects on preventing diseases and managing long-term conditions by looking at a variety of outcomes, including any adverse effects of ATCS but very few studies reported on these.
After searching for studies published between 1980 and June 2015, we found 121 parallel design randomised trials and 5 cluster randomised trials, as well as 6 quasi–randomised studies. More than 4 million participants had been included across this very large body of research. The studies were done in numerous clinical areas, evaluated different types of ATCS and compared these with a variety of alternatives. Forty-one studies were for primary preventive healthcare, such as screening or immunisations. Seven studies tested appointment reminders, which could be used either for preventive health care or for managing chronic conditions; and 84 studies used ATCS for the management of long-term conditions, for instance adherence to medications, managing cancer symptoms, or improving outcomes in hypertension or diabetes.
Not surprisingly, the findings are mixed but I will highlight some of the main ones. For disease prevention, ATCS probably increase immunisation uptake in children, and the number of people screened for breast, cervical or colorectal cancer. When used as appointment reminders, ATCS may reduce the number of people who don’t come for their appointment. While, in the management of long-term conditions, 25 studies looked at the effects of ATCS on medication adherence but the effects of the interventions were variable in size and dependent on the type of ATCS used. No ATCS consistently improved clinical outcomes, such as blood pressure control or control of asthma symptoms, but relatively few studies reported data on clinical outcomes.
In summary, ATCS interventions can change some patients’ health behaviours, improve clinical outcomes and increase uptake of healthcare services with positive effects in several important areas of health. The research needs to continue though. It needs to investigate the most active components of ATCS interventions and the mode of delivery in order to better understand the mechanism of action of this range of interventions. Researchers should also evaluate the experiences of those using ATCS interventions, particularly in terms of the acceptability of these automated systems, and seek to more clearly determine which ATCS types are most effective and cost-effective.
John: If you would like to learn more about automated telephone communication systems, including the different types of technology and to see the full findings from this review of more than 130 studies, go online to Cochrane Library dot com and search ‘ATCS’.