Interactive Voice Response Calls Research Articles

Feasibility of an interactive voice response system for daily monitoring of illicit opioid use during buprenorphine treatment.

In-person retrospective timeline follow-back (TLFB) interviews are a well-established method for collecting self-reports of drug use from patients. However, this method can require significant staff and patient time. In the context of a randomized clinical trial evaluating interim buprenorphine dosing, we examined the feasibility of an interactive voice response (IVR) system for daily monitoring of illicit opioid use during buprenorphine treatment, with a focus on the agreement of illicit opioid use self-report data collected from the concurrent IVR methodology versus retrospective TLFB interviews. Participants (n = 24) received buprenorphine maintenance for 12 weeks and completed nightly IVR calls in which they reported illicit opioid use in the prior 24 hrs. At approximately weekly visits, they provided in-person TLFB reports of illicit opioid use. Levels of data collection were high for both IVR and TLFB methodologies (94.2% vs. 98.5%, respectively) and did not differ. Overall agreement between the 2 methods was high (97%), whereas Cohen's kappa was moderate (k = 0.60). When self-report data were compared with urinalysis results for illicit opioid use, IVR and TLFB approaches both showed high specificity (∼99%), although sensitivity was greater for the TLFB method (48% and 69% for IVR and TLFB, respectively; p = .003). These pilot data suggest that an automated IVR approach may offer an efficient alternative for monitoring self-reported opioid use, especially in rural or resource-constrained settings. Additional efforts to understand and improve IVR sensitivity are warranted. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial

BackgroundAlthough reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported.MethodsFollowing completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures.ResultsOf 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ.ConclusionOverall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.Trial registryClinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.

Effectiveness of short message services and voice call interventions for antiretroviral therapy adherence and other outcomes: A systematic review and meta-analysis.

BackgroundThe potential of using mobile phone technologies to improve antiretroviral therapy (ART) adherence has provided a new facet to human immunodeficiency virus (HIV) research. The quality of evidence and the strength of recommendations of existing reviews, however, do not adequately support large-scale adoption of the intervention. This review adopted broad selection criteria to include all mobile phone-based interventions designed to improve patient’s adherence to ART.MethodsWe performed a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies. PUBMED, MEDLINE, EMBASE, PsychINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED and Web of Science were searched. Online abstracts archives of relevant conference proceedings and trial registries were also searched. Thirty-Five (35) full-text articles were assessed for eligibility. Included studies were conducted in high, low and middle-income countries and reported ART adherence interventions delivered by mobile phones (standard or smartphones) in the form of voice calls, interactive voice response calls (IVR), and short message service (SMS).ResultsThirteen (13) studies met the inclusion criteria, and 11 were used in the meta-analysis. Intervention characteristics of included studies ranged from mobile phone functionalities to provision of study phones to participants. SMS and voice call contents were tailored to participants’ specific adherence needs. Mobile SMS interventions improved adherence to ART compared with control conditions (OR, 95% CI = 1.59, 1.27–1.98). In subgroup analysis, only scheduled SMS was significant whereas triggered SMS had no effect on adherence to ART. Mobile voice calls did not significantly increase adherence to ART. The interventions were highly rated by > 90% of participants in the studies that reported on the experiences and satisfaction with the intervention.ConclusionScheduled mobile phone text-messaging have demonstrated significant improvement in adherence to ART. Mobile SMS adherence interventions that allow for two-way communication may, however, be more acceptable than standalone SMS reminders, which are seen to be intrusive, producing habituation and response fatigue. Voice calls and triggered SMS functionalities do not have a significant effect on adherence to ART although there is a higher preference for voice functionality over SMS especially in limited-resource and low-literacy settings. Further exploration of the mobile voice functionality and its possible combination with scheduled SMS functionality is recommended. Evidence provided in this study will guide the implementation of mobile phone intervention to improve adherence to ART, by addressing practical challenges that could militate against scalability especially in resource limited settings.

Automating Collection of Pain-Related Patient-Reported Outcomes to Enhance Clinical Care and Research.

Chronic pain is highly prevalent, and the ability to routinely measure patients' pain and treatment response using validated patient-reported outcome (PRO) assessments is important to clinical care. Despite this recognition, systematic use in everyday clinical care is rare. The aims of this study were to (1) describe infrastructure designed to automate PRO data collection, (2) compare study-enhanced PRO completion rates to those in clinical care, and (3) evaluate patient response rates by method of PRO administration and sociodemographic and/or clinical characteristics. The Pain Program for Active Coping and Training (PPACT) is a pragmatic clinical trial conducted within three regions of the Kaiser Permanente health care system. PPACT evaluates the effect of integrative primary care-based pain management services on outcomes for chronic pain patients on long-term opioid treatment. We implemented a tiered process for quarterly assessment of PROs to supplement clinical collection and ensure adequate trial data using three methods: web-based personal health records (PHR), automated interactive voice response (IVR) calls, and live outreach. Among a subset of PPACT participants examined (n= 632), the tiered study-enhanced PRO completion rates were higher than in clinical care: 96% completed ≥ 1 study-administered PRO with mean of 3.46 (SD = 0.85) vs. 74% completed in clinical care with a mean of 2.43 (SD = 2.08). Among all PPACT participants at 3months (n= 831), PRO completion was 86% and analyses of response by key characteristics found only that participant age predicted an increased likelihood of responding to PHR and IVR outreach. Adherence to pain-related PRO data collection using our enhanced tiered approach was high. No demographic or clinical identifiers other than age were associated with differential response by modality. Successful ancillary support should employ multimodal electronic health record functionalities for PRO administration. Using automated modalities is feasible and may facilitate better sustainability for regular PRO administration within health care systems. Clinical Trials Registration Number: NCT02113592.

Improving Rates of Outpatient Influenza Vaccination Through EHR Portal Messages and Interactive Automated Calls: A Randomized Controlled Trial.

Patient reminders for influenza vaccination, delivered via electronic health record (EHR) patient portal messages and interactive voice response (IVR) calls, offer an innovative approach to improving patient care. To test the effectiveness of portal and IVR outreach in improving rates of influenza vaccination. Randomized controlled trial of EHR portal messages and IVR calls promoting influenza vaccination. Adults with no documented influenza vaccination 2 months after the start of influenza season (2014-2015). Using a factorial design, we assigned 20,000 patients who were active portal users to one of four study arms: (a) receipt of a portal message promoting influenza vaccines, (b) receipt of IVR call with similar content, (c) both a and b, or (d) neither (usual care). We randomized 10,000 non-portal users to receipt of IVR call or usual care. In all intervention arms, information on pneumococcal vaccination was included if the targeted patient was overdue for pneumococcal vaccine. EHR-documented influenza vaccination during the 2014-2015 influenza season, measured April 2015. Among portal users, 14.0% (702) of those receiving both portal messages and calls, 13.4% (669) of message recipients, 12.8% (642) of call recipients, and 11.6% (582) of those with usual care received vaccines. On multivariable analysis of portal users, those receiving portal messages alone (OR 1.20, 95% CI 1.06-1.35) or IVR calls alone (OR 1.15 95% CI 1.02-1.30) were more likely than usual care recipients to be vaccinated. Those receiving both messages and calls were also more likely than the usual care group to be vaccinated (ad hoc analysis, using a Bonferroni correction: OR 1.29, 97.5% CI 1.13, 1.48). Among non-portal users, 8.5% of call recipients and 8.6% of usual care recipients received influenza vaccines (p = NS). Pneumococcal vaccination rates showed no significant improvement. Our outreach achieved a small but significant improvement in influenza vaccination rates. Registration: ClinicalTrials.gov Identifier NCT02266277 ( https://clinicaltrials.gov/ct2/show/NCT02266277 ).

Engaging Heart Failure Patients with Interactive Voice Response Calls and Multimedia Programs as They Transition from Hospital to Home

Background: When people with heart failure (HF) are discharged from hospitals, they need to manage their condition. Patients are overwhelmed and feel poorly. To avoid complications and readmissions, it’s essential they quickly engage in new behaviors, such as weighing themselves each day. Patients often do not start or maintain these behaviors. Objective: Researchers sought to measure the impact of a user-centered, interactive voice-response (IVR) phone call and multimedia program series (EmmiTransition®) to educate, and motivate patients to take self-care actions post-discharge. Methods: Researchers analyzed call records and conducted aggregate analysis from patients who interacted with the series between August 2013 and May 2016 at UAB Medicine and other healthcare organizations. The 45-day IVR series explains key concepts and behaviors and asks patients to report information like their daily weight. Short multimedia programs provided additional information. Call records from 4,503 patients who completed the series were analyzed. There were 3,615 people who answered and interacted with the calls. Interactions were analyzed to identify the impact on driving people to report their weight daily post-discharge. The percentage of patients who reported weighing themselves daily increased steadily over the first two weeks. After viewing a multimedia program, patients could take an optional survey from Emmi Solutions. Responses and comments were tabulated. Results: On day one of the IVR calls, 66% of UAB Medicine patients who answered the call reported their weight. On day 14 of the calls, 89% of UAB Medicine patients who answered the call reported their weight, comprising a 36% increase in reporting in two weeks. The behaviors seen over the first two weeks were sustained. For the remaining 30 days of the series, 93% of patients who answered calls continued to report their weight. There were 936 patients who opted to take the post-multimedia program survey. The survey findings were as follows: 66% showed increased confidence to ask questions; 75% were prepared to manage their health condition; 75% were more motivated to take their medications; 89% were more aware of how their lifestyle impacts health; 87% were willing to take new action to manage their health; and 88% indicated that they were motivated to change their lifestyle. Examples of patient comments follow: “Read labels and try to decrease processed foods and transfer to whole fruits and vegetables utilizing herbs for seasoning”; “making sure I have a calendar over the bathroom scales to keep track of weight instead of going my memory”; “was not aware diet soda contained high salt count. I will not drink diet sodas as often maybe a glass once or twice a week”; “I will get a flu and pneumonia shot every year. This is not something I did in the past.” Conclusions: Most patients who engaged in this series started a new behavior, regularly reporting they weighed themselves. Most people continued this behavior throughout the 45-day series. Most patients who viewed a multimedia program and completed the survey expressed plans to take specific actions or behavior changes based on information offered by the program about how to weigh themselves, reduce sodium, or manage their fluids.

Capsule Commentary on Rigotti et al., Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials.

Capsule Commentary on Rigotti et al., Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials.

Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials.

Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge. To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation. Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up. A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge. After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling. Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge. Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting. Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge. ClinicalTrials.gov Identifiers NCT01177176, NCT01714323.

MHealth Intervention Elements and User Characteristics Determine Utility: A Mixed-Methods Analysis.

Mobile health (mHealth) interventions are improving the medication adherence of adults with type 2 diabetes mellitus (T2DM), but few studies examine how users experience these interventions. Therefore, we used a mixed-methods approach to understand how T2DM users experience a text messaging and interactive voice response (IVR)-delivered medication adherence intervention called MEssaging for Diabetes (MED). Adults with T2DM used MED as part of a 3-month pilot study. MED sends daily tailored text messages addressing adherence barriers, daily assessment text messages asking about adherence, and weekly tailored IVR calls providing adherence feedback, encouragement, and questions to facilitate problem solving. Sixty participants completed feedback interviews. We used a mixed-methods approach to understand their experience, examining associations between participants' characteristics and their feedback. Participants who completed feedback interviews were on average 50.0 ± 10.1 years old; 65% female, 62% non-white; 15% had less than a high school education, 70% had annual incomes less than $20K; and average hemoglobin A1c was 8.0% ± 1.9%. Participants rated each intervention element favorably; common reasons for MED's helpfulness included receiving novel information about diabetes medications, emotional support, and reminders to take medication. People who were younger and more recently diagnosed with T2DM had more favorable experiences using MED. In general, users valued text messages more than IVR calls. Consideration of the user experience is critical for developing engaging mHealth interventions. User feedback reveals what mHealth elements have the most value and why, which users to target, and how to optimize an intervention's utility and appeal.

Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country.

BackgroundInnovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs).MethodsWe conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction.ResultsOf the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach’s alpha = 0.83). Virtually every participant (97 %) was “mostly” or “very” satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction.ConclusionFindings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective.Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered

A Post-Discharge Smoking-Cessation Intervention for Hospital Patients

Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource. A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling. A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014. Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient's choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge. Biochemically confirmed past 7-day tobacco abstinence 6 months after discharge (primary outcome) and self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months and overall (0-6 months). Analyses were done in 2015-2016. Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7-day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day abstinence over the 6-month follow-up (relative risk, 1.25; 95% CI=1.10, 1.40; p=0.0006). A 3-month post-discharge smoking-cessation intervention for hospitalized smokers who wanted to quit did not increase confirmed tobacco abstinence at 6 months but did increase self-reported abstinence during the treatment period (3 months). Real-time linkage of interactive voice response calls to a quitline, done in this trial to increase scalability of a previously proven cessation intervention, demonstrated short-term promise but did not sustain long-term intervention effectiveness. This study is registered at www.clinicaltrials.gov NCT01714323.

Interactive Voice Response-An Innovative Approach to Post-Stroke Depression Self-Management Support.

Automated interactive voice response (IVR) call systems can provide systematic monitoring and self-management support to depressed patients, but it is unknown if stroke patients are able and willing to engage in IVR interactions. We sought to assess the feasibility and acceptability of IVR as an adjunct to post-stroke depression follow-up care. The CarePartner program is a mobile health program designed to optimize depression self-management, facilitate social support from a caregiver, and strengthen connections between stroke survivors and primary care providers (PCPs). Ischemic stroke patients and an informal caregiver, if available, were recruited during the patient's acute stroke hospitalization or follow-up appointment. The CarePartner program was activated in patients with depressive symptoms during their stroke hospitalization or follow-up. The 3-month intervention consisted of weekly IVR calls monitoring both depressive symptoms and medication adherence along with tailored suggestions for depressive symptom self-management. After each completed IVR call, informal caregivers were automatically updated, and, if needed, the subject's PCP was notified. Of the 56 stroke patients who enrolled, depressive symptoms were identified in 13 (23%) subjects. Subjects completed 74% of the weekly IVR assessments. A total of six subjects did not complete the outcome assessment, including two non-study-related deaths. PCPs were notified five times, including two times for suicidal ideation and three times for medication non-adherence. Stroke patients with depressive symptoms were able to engage in an IVR call system. Future studies are needed to explore the efficacy of an IVR approach for post-stroke self-management and monitoring of stroke-related outcomes.

A Qualitative Evaluation of the Acceptability of an Interactive Voice Response System to Enhance Adherence to Isoniazid Preventive Therapy Among People Living with HIV in Ethiopia

Interactive voice response (IVR) is increasingly used to monitor and promote medication adherence. In 2014, we evaluated patient acceptability toward IVR as part of the ENRICH Study, aimed to enhance adherence to isoniazid preventive therapy for tuberculosis prevention among HIV-positive adults in Ethiopia. Qualitative interviews were completed with 30 participants exposed to 2867 IVR calls, of which 24 % were completely answered. Individualized IVR options, treatment education, and time and cost savings facilitated IVR utilization, whereas poor IVR instruction, network and power malfunctions, one-way communication with providers, and delayed clinic follow-up inhibited utilization. IVR acceptability was complicated by HIV confidentiality, mobile phone access and literacy, and patient-provider trust. Incomplete calls likely reminded patients to take medication but were less likely to capture adherence or side effect data. Simple, automated systems that deliver health messages and triage clinic visits appear to be acceptable in this resource-limited setting.

The impact of health literacy on rural adults' satisfaction with a multi-component intervention to reduce sugar-sweetened beverage intake.

SIPsmartER is a 6-month behavioral intervention designed using a health literacy universal precautions approach that has been found effective at reducing sugary beverage intake in rural, low socioeconomic adults. The purpose of this mixed-methods study is to determine if health literacy status influenced participants' satisfaction and perceptions of each intervention component: small group classes, interactive-voice response (IVR) calls, personal action plans and self-monitoring logs. Of the 155 participants enrolled in SIPsmartER, 105 (68%) completed an interview-administered summative evaluation including 68 high and 37 low health literate participants. The quantitative findings show participant satisfaction with each intervention component was high (i.e. classes = 9.6, IVR calls = 8.1, action plans = 8.9-9.1, logs = 8.7 on a 10-point scale) and similar across both health literacy groups. The majority of qualitative responses were positive (81.8%) and code counts were comparable between literacy groups with a few exceptions. As compared with high health literacy respondents, low health literacy respondents more frequently mentioned liking the content and length of IVR calls, liking the motivational aspects of the personal action plans, and identified numeracy issues with the self-monitoring logs. Overall, applying a health literacy universal precautions approach is an effective and acceptable strategy for both high and low health literacy groups.

Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country.

Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.

Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management.

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs.

Bridging waitlist delays with interim buprenorphine treatment: Initial feasibility

Despite the effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. Interim dosing, consisting of daily medication without counseling, can reduce these risks. In this pilot study, we examined the initial feasibility of a novel technology-assisted interim buprenorphine treatment for waitlisted opioid-dependent adults. Following buprenorphine induction during Week 1, participants (n=10) visited the clinic at Weeks 2, 4, 6, 8, 10 and 12 to ingest their medication under staff observation, provide a urine specimen and receive their remaining doses via a computerized Med-O-Wheel Secure device. They also received daily monitoring via an Interactive Voice Response (IVR) platform, as well as random call-backs for urinalysis and medication adherence checks. The primary outcome was percent of participants negative for illicit opioids at each 2-week visit, with secondary outcomes of past-month drug use, adherence and acceptability. Participants achieved high levels of illicit opioid abstinence, with 90% abstinent at the Week 2 and 4 visits and 60% at Week 12. Significant reductions were observed in self-reported past-month illicit opioid use (p<.001), opioid withdrawal (p<.001), opioid craving (p<.001) and ASI Drug composite score (p=.008). Finally, adherence with buprenorphine administration (99%), daily IVR calls (97%) and random call-backs (82%) was high. Interim buprenorphine treatment shows promise for reducing patient and societal risks during delays to conventional treatment. A larger-scale, randomized clinical trial is underway to more rigorously examine the efficacy of this treatment approach.

Development of models of call center with the system of interactive voice response

The analysis of literature indicates no serious research of call center, which would take into account the impact of interactive voice response (IVR), but at the same time, experience shows that its introduction significantly affects the operational costs of the system owner.That is why the development of adequate models of functioning call center is quite urgent task when designing for leading to the improvement of operation and, therefore, reduces the cash costs of their operation.The work was performed statistical analysis, and the data on the work of the Call-center, a queuing system. IVR system performance was investigated on the developed simulation model in the system GPSS World, experimental studies of developed methods and algorithms are conducted.Number of calls that were serviced, the percentage of lost calls of operators, histogram average waiting time in the queue at different values of the number of working operators, histogram queue length are obtained. They allow predicting the workload of the Call-center, and calculating based on the number of operators required.The research results show that changing the length of the IVR only a few seconds significantly affects the quality parameters of call-center such as the percentage of lost or rejected calls, average wait time, average queue length for operators. With increasing served IVR calls that left behind this system, the average call time in the queue and the average queue length to operators significantly reduced, and the simulation model allows tracking statistics module.Developed and statistical simulation models can be used in the design and operation of call-centers. In the future, it is proposed researching models on the more complex models of call distribution than normal, or exponential.

An Automated Telephone Monitoring System to Identify Patients with Cirrhosis at Risk of Re-hospitalization.

Hospitalizations for cirrhosis are costly and associated with increased mortality. Disease management outside of clinic, such as the use of interactive voice response (IVR) calls, may identify signs to prevent hospitalization. The aim of this study was to investigate whether IVR monitoring can predict hospitalization and mortality in cirrhosis. One hundred patients with decompensated cirrhosis were enrolled in this observational study, of which 79 patients were included in the final analysis. Participants were followed until death, transplant, or last clinical follow-up (range 7-874 days). Analysis focused on potential predictors identified during the first month of IVR calls: presence of jaundice, abdominal/leg swelling, weakness, paracentesis requirement, medication changes, and weight change. The primary outcome was time to first hospital admission; secondary outcomes included hospitalization and time to death. Potential predictors with a p value <0.1 were further analyzed after adjustment for covariates (Model for End-stage Liver Disease score, serum sodium, number of medications). Twenty (25%) patients died, and 49 (62%) were hospitalized at least once. Fifty-six (70%) patients completed >80% of their IVR calls. After adjustment for covariates, weakness was associated with an increased risk of first hospitalization (HR 2.14, CI 1.13-4.05, p = 0.02) and hospitalization rate (HR 2.1, CI 1.0-4.3, p = 0.048). Weight change of ≥ five pounds (2.3 kg) in a week increased the rate of hospitalization by 2.7 (CI 1.0-7.1, p = 0.045). No variable predicted death after covariate adjustment. These results suggest IVR calls can be used to predict hospitalization in cirrhosis.

Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression.

Although telephone care management improves depression outcomes, its implementation as a standalone strategy is often not feasible in resource-constrained settings. Moreover, little research has examined the potential role of self-management support from patients' trusted confidants. To investigate the potential benefits of integrating a patient-selected support person into automated mobile health (mHealth) for depression. Patient preference trial. Depressed primary care patients who were at risk for antidepressant nonadherence (i.e., Morisky Medication Adherence Scale total score > 1). Patients received weekly interactive voice response (IVR) telephone calls for depression that included self-management guidance. They could opt to designate a lay support person from outside their home to receive guidance on supporting their self-management. Patients' clinicians were automatically notified of urgent patient issues. Each week over a period of 6 months, we used IVR calls to monitor depression with the Patient Health Questionnaire-9 (PHQ-9; with total < 5 classified as remission), adherence (single item reflecting perfect adherence over the past week), and functional impairment (any bed days due to mental health). Of 221 at-risk patients, 61% participated with a support person. Analyses were adjusted for race, medical comorbidity, and baseline levels of symptom severity and adherence. Significant interaction effects indicated that during the initial phase of the program, only patients who participated with a support person improved significantly in their likelihood of either adhering to antidepressant medication (AOR = 1.31, 95% CI: 1.16-1.47, p < 0.001) or achieving remission of depression symptoms (AOR = 1.24, 95% CI: 1.14-1.34, p < 0.001). These benefits were maintained throughout the 6-month observation period. Incorporating the "human factor" of a patient-selected support person into automated mHealth for depression self-management may yield sustained improvements in antidepressant adherence and depression symptom remission. However, this needs to be confirmed in a subsequent randomized controlled trial.