Advances in technology can have direct and indirect benefits to clinical practice. The challenge that clinicians face is to properly match resources and outcomes, along with patient preferences. This article explores the use of an innovative interactive voice response system to increase patient compliance with antidepressant medication prescribed in primary care settings. The development of the interactive voice response system, its implementation, and clinical outcomes are described. The findings underscore the need to carefully match intervention strategies with the needs of specific patient populations, and the importance of human dialog in the context of healing.
"Advice over the telephone and monitoring of medication, especially at the outset of treatment in primary care, have also proven useful,99-101 as have informational mailings, either exclusively102 or in combination with telephone advice.103 An interactive voice response system for improving compliance with antidepressant treatment is currently being developed with promising results.104 "
[Show abstract][Hide abstract] ABSTRACT: In psychiatry, one of the main factors contributing to poor response to pharmacological treatment is adherence. Noncompliance with maintenance treatments for chronic illnesses such as schizophrenia and affective disorders can exceed 50%, Poor adherence can be due to drug-related factors (tolerance, complexity of prescription, side effects, or cost), patient-related variables (illness symptoms, comorbidity, insight capacity, belief system, or sociocultural environment), and physician-related factors (communication or psychoeducational style). Psychosocial treatments must be used in conjunction with medication during the maintenance phase to improve adherence to treatment and to achieve - through the management of psychological variables - better social, work, and family functioning. This article reviews the concepts of adherence and noncompliance, and their impact on maintenance treatments, as well as the effect of dealing with psychosocial factors in psychiatric treatment.
Dialogues in clinical neuroscience 03/2004; 6(1):93-103.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTIONAdverse events (AEs) are poor outcomes caused by medical care. They occur in 20% of medical patients following hospital discharge.
We designed an interactive voice response system (IVRS) with the intent of identifying patients who might be experiencing
an AE following discharge or were at risk of developing one.
OBJECTIVESWe determined the proportion of post-discharge patients requiring an intervention after identifying potential problems using
the IVRS, the relationship between IVRS responses and AE occurrence, and patients’ opinions of the IVRS call.
METHODSWe studied patients discharged from the general medical service of an academic hospital. The IVRS called patients 2 days post-discharge
and asked three questions to determine the need for nurse follow-up. We contacted patients 30days later to elicit AE status
and perceptions of the IVRS.
RESULTSOur cohort consisted of 270 elderly patients [median 64years (IQR 50-76)] with multiple co-morbidities. Responses to the
IVRS identified 57 patients (21%, 95% CI 17%-27%) for follow-up. When contacted by a nurse, 25 patients (9%, 95% CI 6%-13%)
actually required an intervention. At 30-day follow-up, AEs occurred in 33 patients (12%, 95% CI 8%-17%). Only three AEs (9%)
were identified by the IVRS; the remainder occurred before or after the IVRS call. Patients remembering the IVRS call found
it easy to use (97%), and a minority would prefer a person to call (8%).
CONCLUSIONAn IVRS-based method of monitoring was acceptable to patients and identified a significant proportion requiring changes in
management. However, the method identified only a minority of AEs. To have a significant improvement in care, this method
will need to be combined with other interventions.
Journal of General Internal Medicine 04/2009; 24(4):520-525. DOI:10.1007/s11606-009-0910-3 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated the effects of interactive voice response (IVR) system reminders to managed care organization (MCO) members to obtain mammograms, Papanicolaou (Pap) tests, and influenza immunizations. The MCO identified 3 member cohorts and sent IVR reminders to get preventive services. Analyses employed claims data to examine relationships between IVR reminders and preventive service use 5 to 9 months post-intervention among members without prior utilization. Multivariate logistic regressions controlling for age, gender (for influenza immunizations), and risk stratum confirmed hypothesized relationships between intervention and preventive services: mammograms, odds ratio (OR) = 1.263 (95% confidence interval [CI] = 1.104, 1.444); Pap tests, OR = 1.241 (1.107, 1.391); influenza immunizations, OR = 2.072 (1.665, 2.580). IVR reminders are associated with higher rates of mammograms, Pap tests, and influenza immunizations. Study limitations include unknown generalizability of results and possible self-selection. There is justification for more IVR interventions and research to enhance MCO members' preventive service utilization.
American Journal of Medical Quality 11/2005; 20(6):329-36. DOI:10.1177/1062860605281176 · 1.25 Impact Factor
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