Cochrane · systematic review · CD009921
Automated telephone communication systems for preventive healthcare and management of long‐term conditions
Posadzki, P, Mastellos, N, Ryan, R, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Consumers and CommunicationAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
79
current version
GRADE rated
48
No studies
14
Included studies
NR
No studies 14 · 17.7%Ungraded 17 · 21.5%Very low 2 · 2.5%Low 23 · 29.1%Moderate 20 · 25.3%High 3 · 3.8%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Preventive healthcare: effects of ATCS on health services uptake (immunisations)
Population: participants at risk of under‐immunisation (children, adolescents and adults)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcome: immunisation rate ATCS Plus, IVR, unidirectional versus no calls, letters, usual care at median | RR 1.25 [1.18, 1.32] | 5 studies · 10454 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: immunisation rate Unidirectional ATCS versus usual care at median | RR 1.06 [1.02, 1.11] | 2 studies · 5725 participants | Moderate Downgraded: risk of bias |
Behavioural outcome: immunisation rate Unidirectional ATCS versus no calls or health information at median | RR 2.18 [0.53, 9.02] | 2 studies · 1743 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse outcome: unintended adverse events attributable to the intervention ATCS+, IVR, unidirectional versus various controls | no estimate extracted | NR | No studies |
Preventive healthcare: effects of ATCS on physical activity levels
Population: participants at risk of developing long‐term conditions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcome: physical activity Multimodal/complex interventionb versus no calls | no estimate extracted | 1 study · 181 participants | Low Downgraded: risk of bias, imprecision |
Behavioural outcome: physical activity, 12 months Multimodal/complex interventiond versus usual care | no estimate extracted | 2 studies · 700 participants | Ungraded |
Behavioural outcome: physical activity ATCS Plus versus IVR control | no estimate extracted | 2 studies · 369 participants | Low Downgraded: risk of bias, imprecision |
Behavioural outcome: physical activity IVR versus usual care, control or health education | no estimate extracted | 3 studies · 216 participants | Low Downgraded: risk of bias, imprecision |
Clinical outcome: metabolic markers, 12 months Multimodal/complex interventiond versus usual care | no estimate extracted | 1 study · 302 participants | Low Downgraded: risk of bias, imprecision |
Clinical outcome: body weight measures Multimodal/complex interventiond ATCS Plus versus usual care or control | no estimate extracted | 2 studies · 373 participants | Low Downgraded: risk of bias, imprecision |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR versus various controls | no estimate extracted | NR | No studies |
Preventive healthcare: effects of ATCS on health services uptake (screening)
Population: participants at risk for breast, colorectal or cervical cancer; or osteoporosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcome: breast cancer screening Multimodal/complex intervention versus usual care at 12 months | RR 2.17 [1.55, 3.04] | 2 studies · 462 participants | High |
Behavioural outcome: breast cancer screening IVR versus enhanced usual care at median | RR 1.05 [0.99, 1.11] | 2 studies · 2599 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: colorectal cancer screening Multimodal/complex intervention versus usual care at median | RR 2.19 [1.88, 2.55] | 3 studies · 1013 participants | High |
Behavioural outcome: colorectal cancer screening IVR versus usual care at 6‐month | RR 1.36 [1.25, 1.48] | 2 studies · 16915 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: colorectal cancer screening IVR, unidirectional ATCS versus usual care or letter at longer (9‐12 months) | RR 1.01 [0.97, 1.05] | 2 studies · 21335 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: cervical cancer screening ATCS Plus versus control (no calls) at 3 month | no estimate extracted | 1 study · 75532 participants | Moderate Downgraded: risk of bias |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional versus various controls | no estimate extracted | NR | No studies |
Preventive healthcare: effects of ATCS on weight management
Population: overweight or obese individuals (both children and adults)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical and behavioural outcome: BMI score in adults Multimodal/complex intervention, ATCS Plus or IVR versus usual care at median | no estimate extracted | 3 studies · 672 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Clinical and behavioural outcome: body weight in adults, 12 weeks | no estimate extracted | NR | No studies |
Clinical and behavioural outcome: body weight in adults, at median | no estimate extracted | NR | No studies |
Clinical and behavioural outcome: blood pressure, blood glucose, cholesterol levels | no estimate extracted | NR | No studies |
Clinical outcome: BMI z‐score in children at median | no estimate extracted | NR | Moderate |
Behavioural outcome: physical activity, dietary habits in children at median | no estimate extracted | NR | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse outcome: unintended adverse events attributable to the intervention IVR versus usual care | no estimate extracted | 2 studies · 559 participants | Ungraded |
Preventive healthcare or management of long‐term conditions: effects of ATCS as appointment reminders/reducing non‐attendance rates
Population: patients/healthcare consumers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Health behaviour: attendance rates, 6 weeks ATCS Plus versus nurse‐delivered calls | no estimate extracted | 1 study · 3610 participants | Moderate Downgraded: risk of bias |
Health behaviour: attendance rates, 4 months IVR versus no calls | no estimate extracted | 1 study · 12092 participants | High |
Health behaviour: return tuberculin test rate, 3 days Unidirectional ATCS versus no calls | no estimate extracted | 1 study · 701 participants | Low Downgraded: risk of bias |
Health behaviour: attendance rates, 1 month Unidirectional ATCS versus no calls | no estimate extracted | 1 study · 517 participants | Low Downgraded: risk of bias |
Health behaviour: attendance rates, 6‐8 weeks Unidirectional ATCS versus no calls | no estimate extracted | 2 studies · 3304 participants | Moderate Downgraded: risk of bias |
Health behaviour: attendance rates, 6 months Unidirectional ATCS versus no calls | no estimate extracted | 1 study · 2008 participants | Low Downgraded: risk of bias |
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR, unidirectional ATCS versus various controls | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS on adherence to medication or laboratory tests
Population: patients with various conditions or at risk of low adherence to medication or laboratory tests
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcome: adherence to medication Multimodal/complex interventionsb versus usual care or control | no estimate extracted | 2 studies · 888 participants | Ungraded |
Behavioural outcome: adherence to medication ATCS Plus versus control or single IVR call | no estimate extracted | 2 studies · 2340 participants | Ungraded |
Behavioural outcome: adherence to laboratory tests ATCS Plus or IVR versus no intervention or usual care | no estimate extracted | 3 studies · 15218 participants | Ungraded |
Behavioural outcome: adherence to medication or composite outcome (medication adherence and rate of adverse events) ATCS Plus versus usual care | no estimate extracted | 4 studies · 35816 participants | Ungraded |
Behavioural outcome: adherence to medication or laboratory tests IVR versus control | no estimate extracted | 4 studies · 4238362 participants | Ungraded |
Behavioural outcome: adherence to medication IVR versus usual care | no estimate extracted | 8 studies · 56140 participants | Ungraded |
Behavioural outcome: adherence to medication Unidirectional ATCS versus control | no estimate extracted | 2 studies · 107 participants | Ungraded |
Clinical outcome: blood pressure Multimodal/complex, ATCS Plus, IVR versus usual care | no estimate extracted | 3 studies · 22597 participants | Ungraded |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional versus various controls | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS on alcohol consumption
Population: participants addicted to alcohol
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcomes: number of drinks per drinking day ATCS Plus, IVR versus usual care, (various) controls at median | no estimate extracted | 3 studies · 459 participants | Low Downgraded: risk of bias |
Behavioural outcomes: drinking days, heavy drinking days, or total number of drinks consumed ATCS Plus, IVR versus (various) controls | no estimate extracted | 3 studies · 217 participants | Low Downgraded: risk of bias |
Behavioural outcomes: proportion of days abstinent, other alcohol consumption indices, 12 weeks ATCS Plus versus control (packaged CBT) | no estimate extracted | 1 study · 110 participants | Low Downgraded: risk of bias |
Behavioural outcomes: weekly alcohol consumption, 6 months ATCS Plus versus usual care | no estimate extracted | 1 study · 338 participants | Low Downgraded: risk of bias |
Behavioural outcomes: AUDIT score, 6 weeks IVR versus control (no intervention) | no estimate extracted | 1 study · 1423 participants | Moderate Downgraded: risk of bias |
Behavioural outcomes: other alcohol consumption indices, 4 weeks IVR versus control (no intervention) | no estimate extracted | 1 study · 98 participants | Low Downgraded: risk of bias |
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus various controls | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS on severity of cancer symptoms
Population: cancer patients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical outcomes: symptoms (severity or burden) ATCS Plus versus usual care (via ATCS) or control, 4‐12 weeks | no estimate extracted | 4 studies · 701 participants | Ungraded |
Clinical outcomes: symptom severity, 10 weeks IVR versus nurse delivered calls | no estimate extracted | 1 study · 437 participants | Low Downgraded: risk of bias, imprecision |
Clinical outcomes: pain Multimodal/complex interventiong versus usual care | no estimate extracted | 1 study · 405 participants | Moderate Downgraded: risk of bias, imprecision |
Clinical outcomes: depression Multimodal/complex interventiong versus usual care | no estimate extracted | 1 study · 405 participants | Moderate Downgraded: risk of bias, imprecision |
Clinical outcomes:distress, 6 weeks ATCS Plus versus usual care (via IVR) | no estimate extracted | 1 study · 250 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: medication adherence ATCS Plus versus usual care | no estimate extracted | 1 study · 119 participants | Low Downgraded: risk of bias, imprecision |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR versus various controls | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS in the management of diabetes mellitus
Population: patients with diabetes mellitus
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical outcome: glycated haemoglobin or blood glucose ATCS Plus, IVR versus usual care at median | no estimate extracted | 7 studies · 1216 participants | Low Downgraded: risk of bias, inconsistency |
Behavioural outcome: self‐monitoring of diabetic foot (various scales) ATCS Plus versus usual care at 12 months | no estimate extracted | 2 studies · 498 participants | Moderate Downgraded: risk of bias, imprecision |
Behavioural outcome: self‐monitoring of blood glucose ATCS Plus, IVR versus usual care, 6‐12 months | no estimate extracted | NR | No studies |
Behavioural outcome: medication adherence or use ATCS Plus versus usual care, 6‐12 months | no estimate extracted | 2 studies · 370 participants | Ungraded |
Behavioural outcome: physical activity, diet, weight monitoring ATCS Plus versus usual care, 6‐12 months | no estimate extracted | 3 studies · 1028 participants | Ungraded |
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus usual care | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS in patients with heart failure
Population: patients with heart failure
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical outcome: cardiac mortality ATCS Plus, IVR versus usual care or usual community care at median | RR 0.6 [0.21, 1.67] | 2 studies · 215 participants | Very low Downgraded: risk of bias, imprecision |
Clinical outcome: all‐cause mortality ATCS Plus versus usual care or usual community care at median | RR 1 [0.79, 1.28] | 3 studies · 2165 participants | Moderate Downgraded: risk of bias, imprecision |
Clinical outcome: heart failure hospitalisation ATCS Plus, IVR versus usual care or usual community care at median | no estimate extracted | 4 studies · 2329 participants | Ungraded |
Clinical outcome: all‐cause hospitalisation ATCS Plus versus usual care or usual community care | no estimate extracted | 3 studies · 2191 participants | Ungraded |
Clinical outcome: global health (well‐being) rating (7‐item questionnaire) ATCS Plus versus usual care 12 months | no estimate extracted | 1 study · 405 participants | Moderate Downgraded: imprecision |
Clinical outcome: emergency room and other health service use outcomes ATCS Plus versus usual care or usual community care | no estimate extracted | 2 studies · 1786 participants | Ungraded |
Adverse outcome: unintended adverse events attributable to the intervention ATCS Plus, IVR versus usual care | no estimate extracted | 2 studies · 1791 participants | Ungraded |
Long‐term management: effects of ATCS in the management of hypertension
Population: patients with hypertension
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical outcome: systolic blood pressure (automated sphygmomanometer or electronic pressure monitor) ATCS Plus or IVR versus usual care at median | no estimate extracted | 3 studies · 65256 participants | Moderate Downgraded: risk of bias, imprecision |
Clinical outcome: diastolic blood pressure (automated sphygmomanometer and electronic cuff) ATCS Plus, unidirectional versus usual care at median | no estimate extracted | 2 studies · 65056 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Clinical outcome: blood pressure control, 26 weeks Multimodal/complex interventionf versus usual care | no estimate extracted | 1 study · 166 participants | Moderate Downgraded: risk of bias |
Clinical outcome: Health statush, depressioni, 6 weeks ATCS Plus versus enhanced usual care (plus information) | no estimate extracted | 1 study · 200 participants | Low Downgraded: risk of bias |
Behavioural outcome: medication use Multimodal/complexk, ATCS Plus versus usual care or enhanced usual care (plus information) | no estimate extracted | 2 studies · 483 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Behavioural outcome: physical activity levels, 12 weeks IVR versus enhanced usual care | no estimate extracted | 1 study · 253 participants | Low Downgraded: risk of bias |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR, unidirectional ATCS versus various controls | no estimate extracted | NR | No studies |
Long‐term management: effects of ATCS on smoking cessation
Population: patients with tobacco dependence
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behavioural outcome: smoking abstinence Multimodal/complex intervention, ATCS Plus, IVR versus (various) controls or usual care at median | RR 1.2 [0.98, 1.46] | 7 studies · 2915 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Behavioural outcome: medication use Multimodal/complex, ATCS Plus versus control (inactive IVR or self‐help booklet) | no estimate extracted | 2 studies · 1127 participants | Moderate Downgraded: imprecision |
Behavioural outcome: support programme enrolment ATCS Plus versus control (inactive IVR) | no estimate extracted | 1 study · 521 participants | Low Downgraded: risk of bias, imprecision |
Adverse outcome: unintended adverse events attributable to the intervention Multimodal/complex intervention, ATCS Plus, IVR versus various controls | no estimate extracted | NR | No studies |