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

Posadzki P et al. (2016)

Cochrane Database of Systematic Reviews - 10.1002/14651858.CD009921.pub2

Go to publication

Evidence Categories

• Care setting: Primary care
• Population group: Pregnancy/ post-partum
• Population group: Older adults
• Intervention: Reminder/recall (patient)
• Intervention: Health literacy
• Outcome: Uptake of vaccinations

Type of Evidence

Systematic Review

Aims

"To assess the effects of ATCS for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes."

Findings

"Only two studies fulfilled the inclusion criteria of this evidence map (Hess, 2013; Nasar, 2014):

'Meta-analysis of the two studies found that the effects of unidirectional ATCS, compared with no calls in Hess (2013) or health information in Nassar (2014) were uncertain for immunisations in adults (RR 2.18, 95% CI 0.53 to 9.02; very low certainty evidence).'

In regards to the wider review, the authors state that:

We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty‐one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long‐term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes.

For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 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% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty).

Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long‐term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined)."

Conclusions

The authors state that:

"ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective."