Reports from the Field
Interactive voice system improves outcomes
Interactive voice response (IVR) systems moderately improve the outcomes of patients with chronic diseases such as diabetes and depression, according to a review of studies conducted between 1985 and 1999.
IVR assessment is often used to indicate when a diabetes patient’s blood sugar levels are too high, or when a person is struggling with depression. Patients using IVR receive recorded messages and report clinical information using their telephone touch-tone keypad or voice recognition technology. Patients are more likely to report sensitive information accurately in their interactions with IVR systems than they are during in-person interviews, according to the retrospective review. In addition, patients can access IVR systems more frequently and conveniently than their physician’s office or outpatient clinic, notes John D. Piette, PhD, of the Palo Alto Veteran’s Administration Center for Health Care Evaluation and Stanford University in California.
The studies showed the benefit of IVR systems on patient outcomes. For example, in one study patients with diabetes who used an IVR system to obtain health information, report changes in blood glucose levels, and access a decision-support system for making insulin dose adjustments, had a threefold decrease in diabetes crises and an average glycosylated hemoglobin of 0.8%. Another study showed that diabetes patients who used an IVR system had improved self-care and fewer symptoms of poor glycemic control than similar patients who received usual care.
Piette also found that nurse educators used IVR assessment information to identify patients needing additional counseling, which was provided via follow-up telephone calls. Patients using the IVR system also reported fewer symptoms of depression and days in bed due to illness than patients receiving usual care. Another study found that hypertensive patients who received weekly IVR monitoring with feedback of their assessment data from physicians, when necessary, had improved medication adherence and decreased diastolic blood pressure compared with usual-care patients.
Piette says the studies suggest that IVR assessments may be a useful adjunct to care for patients with a variety of chronic physical and mental illnesses. Patients who face barriers to self-management, such as lack of social support, poor English competence, poor health literacy, or mental health problems, may benefit even more from the additional oversight afforded by periodic IVR assessments, he adds.
[See: Piette JD. Interactive voice response systems in the diagnosis and management of chronic disease. Am J of Man Care 2000; 6(7):817-827.]
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