February 2017 | Issue 28
Automated telephone communication systems can change health behaviour

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By Nicole Lim, Assistant Director, Communications & External Relations

Automated telephone communication systems (ATCS) can improve people’s behaviours when it comes to managing their health, a new Cochrane Review found. Published last December, the review concluded that ATCS are effective in the areas of immunisation, routine cancer screening, and appointment reminders.
LKCMedicine Associate Professor of Health Services Outcomes Research Josip Car, who led the review, said, “ATCS offer a number of advantages over traditional face-to-face consultations, including convenience, accessibility, ease of use, and low cost.”

ATCS are defined as systems that send voice messages and collect health data from people via touchtone keypad responses to recorded questions or spoken answers using voice recognition software. They can be categorised into four types: unidirectional (one-way, non-interactive voice communication), interactive voice response, ATCS with additional functions such as access to an expert and multimodal ATCS, in which calls were delivered as part of a multipronged intervention.

The team synthesised the evidence generated by 132 trials involving more than four million participants, assessing the effectiveness of ATCS in preventive healthcare and management of long-term conditions.
Of the 132 studies, the team found that most (84 studies) focused on managing chronic conditions, 41 on preventive healthcare and seven studied the effectiveness of ATCS as appointment reminders.

Highlighting some of the main findings, Senior Research Fellow in Assoc Prof Car’s team Dr Pawel Posadzki said, “For disease prevention, ATCS probably increased immunisation uptake in children and the number of people who went for breast, cervical and colorectal cancer screenings.”

In addition, the review found evidence that attendance at medical appointments can be increased with ATCS support.

When examining the effects of ATCS on long-term disease management, such as adherence to medication, the review found the evidence on the effects of such interventions variable and dependent on the type of ATCS used.

Dr Posadzki said, “No ATCS consistently improved clinical outcomes, such as blood pressure control or control of asthma symptoms.”

However, given the flexibility of such systems and the high degree to which they can be customised, ATCS can be an effective way to supplement or even replace telephone contact between health professionals and patients, freeing these professionals to spend more time with patients during face-to-face appointments.
An area that the team highlighted for further study is cost-effectiveness as evidence on this was lacking in the data. More work on dissecting such interaction and identifying the most effective approaches and components is also required.

Hurdles to implementing such systems include data protection, confidentiality, integration with other electronic records as well as language preferences.

Summing up the review, Assoc Prof Car, who is also Director of the Health Services Outcomes Research Programme and Centre for Population Health Sciences, said, “ATCS have the potential to play an important role in the delivery of modern healthcare as they are capable of changing specific health behaviours and improving people’s health outcomes.”