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Use of interactive voice response systems by patients with chronic diseases can improve outcomes

Interactive voice response (IVR) systems can moderately improve the outcomes of patients with chronic diseases such as diabetes, back pain, and depression, according to this review of research conducted between 1985 and 1999. IVR assessment can indicate when a diabetes patient's blood sugar level is too high, when a person is struggling with depression, or when back pain is negatively affecting a patients quality of life.

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. Also, patients can access IVR systems more frequently and conveniently than a doctor's office or outpatient clinic, explains John D. Piette, Ph.D., of the VA Center for Health Care Evaluation and Stanford University. Dr. Piette's work was supported by the Agency for Healthcare Research and Quality (HS10281).

The studies reviewed by Dr. Piette 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 control, and access a decision-support system for making insulin dose adjustments had a three-fold decrease in diabetes crises and an average in glycosylated hemoglobin of 0.8 percent (absolute). 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.

Nurse educators used IVR assessment information to identify patients needing additional counseling which was provided via followup 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. In addition, another study found that hypertensive patients who received weekly IVR monitoring with feedback of their assessment data to physicians had improved medication adherence and decreased diastolic blood pressure compared with usual care patients.

These studies suggest that IVR assessments may be a useful adjunct to care for patients with a variety of chronic physical and mental illness. 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.

See "Interactive voice response systems in the diagnosis and management of chronic disease," by Dr. Piette, in the July 2000 American Journal of Managed Care 6(7), pp. 817-827.

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