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Systematic Review
This Cochrane review aimed to assess the effects of automated telephone communication systems (ATCS) for preventing disease and managing long‐term conditions on behavioural change, clinical, process, cognitive, patient‐centred and adverse outcomes.
The reviewers 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. They downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. They judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. They considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear. Only results relevant to this evidence map have been extracted below.
For preventive healthcare, ATCS (ATCS Plus, interactive voice response , unidirectional) probably increase immunisation uptake in children (RR 1.25, 95% 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).
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.