Study of patients with depression calls into question IVR frequency

The technical feasibility of gathering high frequency health data via Interactive Voice Response (IVR) may in some instances exceed the clinical benefit of doing so, finds an article in the Journal of Medical Internet Research.

IVR is an automated phone information system that speaks to the caller with a combination of fixed voice menus and data extracted from databases in real time. The caller responds by pressing digits on the phone or speaking words or short phrases.

"Clinicians and health care payers increasingly look to mobile health services such as IVR as tools for monitoring patients' status between face-to-face encounters and identifying individuals who need attention to prevent acute events," states the article.

The study, supported by the Department of Veterans Affairs Health Services Research and Development Program, evaluated whether frequent (i.e., weekly) IVR assessment attempts were significantly more predictive of patients' subsequent reports than information collected biweekly or monthly. Using data from 1,050 IVR assessments for 208 patients with depression diagnoses, the authors examined the predictability of four IVR-reported outcomes: moderate/severe depressive symptoms, fair/poor general health, poor antidepressant adherence, and days in bed due to poor mental health. 

All patients received IVR calls at regular intervals, during which they completed the Patient Health Questionnaire, a widely used and validated depression assessment scale. Also, patients repeatedly answered questions regarding their antidepressant medication adherence, perceived general health, and days in bed due mental health problems.

"Weekly or biweekly depressive symptom reports may provide little marginal information regarding how the person is doing relative to collecting that information monthly," concludes the article. "The next generation of automated health assessment services should use data mining techniques to avoid redundant assessments and should gather data at the frequency that maximizes the value of the information collected."

The McKesson Foundation announced in October 2012 that it awarded a research grant to the Center for Connected Health in Boston, a division of Partners HealthCare, to develop a text messaging program to improve pain management in cancer patients. The study leverages text messaging and IVR technology to collect self-reported pain assessments, monitor the impact of pain on patients' daily lives, and provide tailored, multi-dimensional and supportive feedback.

Kamal Jethwani, M.D., corporate manager for research and innovation at the Center for Connected Health, and Principal Investigator for the study, said there is increasing evidence for the use of IVR technologies in mHealth interventions because it is "low cost, convenient, reliable and effective for symptom and treatment monitoring in chronic disease management."

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