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Table 1 Using Telephones as a Healthcare Intervention: Fixed Phones

From: Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries?

Country Indication/Disease Intervention Results Reference/Comments
Newfoundland Canada Diabetes outcomes To assess whether modem link from patient at home to hospital improves diabetes control. RCT: transmission of blood data via modem;
N = 42.
Patients in "telephone group" performed five blood glucose determinations/day twice/week and transferred data via phone once/week. Control group brought results in to clinic every 6 wk.
"Telephone" group counselled every week via telephone to adjust insulin and food intake Duration = 12 weeks.
In treatment group, HbA1c improved from 0.106 to 0.092 (13.20%). The control group improved from 0.112 to 0.102 (8.9%). No significant change in weight, random blood glucose, or insulin. [14]
United States Breast cancer: mammography RCT: in-person v. telephone v. no mammography counselling.
N = 1098.
Duration = 4 weeks
Compared to no counselling, telephone counselling was more than twice as effective at increasing mammography adherence, and in-person counselling resulted in almost three times the mammography adherence. [15]
United States Tuberculosis: adherence to medication Observational videophone Directly Observed Therapy, Short Course (DOTS) program v. standard DOTS. Two way links between home and health department.
N = 6.
Duration = 24 months
During 304 video- observed treatment doses, adherence was 95%, and patient acceptance of the technology was excellent. Adherence on standard DOT was 97.5%. A total of 8830 driving miles were avoided/288 travel hours [16] "In selected cases, the use of videophone technology can maintain a high level of adherence to DOT in a cost-effective manner"
United States Various indications: patient outcomes RCT: follow-up phone call by a pharmacist 2 days after discharge from hospital.
N = 221.
Data collected on patient satisfaction and outcomes.
Duration = 7 months
Phone call group more satisfied with discharge medication instructions (86% vs. 61%, P = 0.007). Fewer patients from phone group returned to ER within 30 days (10% phone call vs. 24% no phone call, P = 0.005). [17]
United States Hypertension :adherence to medication RCT: usual medical care v. computer-controlled telephone system in addition to usual medical care to promote adherence.
N = 267
Duration = 6 months
Mean antihypertensive medication adherence improved 17.7% for telephone system users and 11.7% for controls (P = .03). Mean DBP decreased 5.2 mm Hg in users compared to 0.8 mm Hg in controls (P = .02). [18]
United States Hypercholesterolemia: maintenance of change RCT: Computer assisted telephone: two calls/month for six months v. no calls to maintain initial cholesterol change and provide feedback for patients completing a diet and behavioral cholesterol reduction program.
N = 115
Duration = 6 months
Neither group fully maintained initial cholesterol reductions [19]
United States Diabetes outcomes Observational study: Voice-interactive telephone system (daily self-measured glucose levels or hypoglycemic symptoms).
N = 184
Duration = 12 months
Yearly prevalence of diabetes-related crises or hypoglycemia decreased from 3% of total calls to 2% (P < 0.05), with a concomitant statistically significant decrease in Type 2 diabetic HbA1c from 9.7, (SD = 1.03) to 8.6, (SD = 1.54, p = .03) [20]
United States Attendance at adolescent clinic CT: Telephone reminder 1 day before clinic appointment v. no reminder.
N = 703
Duration = 11 months
Attendance rate (65.2%) in intervention group was increased by 47.8% over control [21]
United States Diabetes outcomes CT: Type 1 diabetes
N = 10
Duration = 6 months
Proactive telephone intervention delivered by psychology undergraduates (15-min telephone intervention weekly for 3 months and biweekly for 3 additional months) Intervention group showed 1.2% drop in HbA1c; control group an increase of 0.8%., p < .05 [22]
United States Depression outcomes RCT: usual care v. telephone care management (feedback to patients/algorithm based intervention) v. telephone care management plus treatment recommendations/practice support
N = 613
Compared with usual care, the practice telephone support intervention led to lower mean depression scores (2.59, P = .008). Compared with usual care, feedback only had no significant effect on treatment received or patient outcomes. Patients receiving feedback plus care management had a higher probability of both receiving at least moderate doses of antidepressants (odds ratio 1.99, 95% confidence interval 1.23 to 3.22) and a lower probability of major depression at follow up (OR = 0.46, 0.24 to 0.86). [23]
United States Immunization rates Computer-generated telephoned reminders v. control intervention to raise the rates of on-time immunization among preschool-age children in two public clinics in Atlanta, GA. Intervention group households had faster vaccinations (adjusted OR = 2.12: 1.01, 4.46) but the overall effect of the intervention on immunization levels appeared to be minimal (crude relative risk = 1.07, 95 percent confidence interval = 0.78, 1.46). Only 80 percent of children in both groups were members of a household with a telephone number listed in clinic records. [24]
United States Hypertension adherence to medication RCT: Nurse administered- intervention via telephone bimonthly v. usual care for hypertension.
N = 294
Duration = 2 years
Blood pressure (BP) control not yet reported. Patients with nurse intervention had a greater increase in confidence of their BP management following hypertension treatment than the usual care group. [25]
United States HIV Cross sectional study within clinical trial: Compare and contrast three different methods for measuring self reported ARV adherence: nurse rating, self report and recall phone interview.
N = 35 adolescents
Little agreement between phone calls, clinical nurse rating and self report regarding the level of adherence. [26] Phone calls were time and labor intensive. "... not recommended as part of regular clinical practice".
Various Immunization Rates Cochrane Review All types of reminders were effective (postcards, letters, telephone or autodialer calls), with telephone being the most effective but most costly. Effect on rates for childhood vaccinations (OR = 2.02, 95% CI = 1.49,2.72), for childhood influenza vaccinations (OR = 4.19, 95% CI = 2.07,8.49), for adult pneumococcus or tetanus (OR = 5.14, 95%CI = 1.21, 21.8), and for adult influenza vaccinations (OR = 2.29, 95%CI = 1.69, 3.10). [27]
  1. RCT = randomised controlled trial; CT = controlled trial