Automated telephone communication systems for preventive healthcare and management of long-term conditions

摘要

BackgroundudAutomated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patientsudusing either their telephone’s touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contactudbetween health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voiceudcommunication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request adviceud(ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention.udObjectivesudTo assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process,udcognitive, patient-centred and adverse outcomes.udSearch methodsudWe searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL;udGlobal Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses,udAustralasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published betweenud1980 and June 2015.udSelection criteriaudRandomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCSudinterventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in anyudpreventive healthcare or long term condition management role were eligible.udData collection and analysisudWe used standard Cochrane methods to select and extract data and to appraise eligible studies.udMain resultsudWe included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluationudof different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 forudmanaging long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarilyudbecause of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over halfudthe studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due toudblinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcomeudreporting to be unclear.udFor preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR)ud1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RRud1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CIud0.53 to 9.02; 2 studies, N = 1743; very low certainty).udFor screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462;udhigh certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care.udIt may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderateudcertainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36,ud95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVRud(RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.udAppointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (lowudcertainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditionsud(25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medicationudadherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improvesudmedication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medicationudadherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increasesudmedication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS,udcompared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little orudno consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage)udrelated to adherence, but only a small number of studies contributed clinical outcome data.udThe above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCSudvaried, including by the type of ATCS intervention in use.udMultimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCSudtypes were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity,udweight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure,udhypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/udsubstance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia,udobstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.udOnly four trials (3%) reported adverse events, and it was unclear whether these were related to the interventions