Automated Telephone Interview Enhances Pediatric Visits

Marcia Frellick

August 05, 2014

When parents answered automated questions by telephone before routine pediatric visits, and physicians could access the answers through the patient's electronic health record, quality of care improved, a new study suggests.

William Adams, MD, from the Division of General Pediatrics, Boston University School of Medicine, Massachusetts, and colleagues tested a voice response system they developed called Personal Health Partner (PHP), which is integrated with a patient's electronic health record (EHR). It is programmed to ask questions via telephone on topics such as depression, diet, screen time, and child's medication use.

The researchers recruited English-speaking parents of children aged 4 months to 11 years from the Pediatric Primary Care Center at Boston Medical Center, which serves an urban, predominantly lower-socioeconomic-status population, and 593 parents (8.6%) responded.

The parents were instructed to call in to the PHP system before scheduled routine pediatric appointments. The system randomly assigned them at the time of the call into either the PHP group or a control group that took the 18-question Framingham Safety Survey only.

For the intervention group, spoken responses triggered the system to provide counseling and goals for the visit. For example, if a parent screened positive for depression, the system let the parent know that the physician is interested in that information and asked the parent to bring up feelings of sadness during the visit.

Parents in the intervention group were more likely to discuss issues such as depression (42.6% vs 25.4%; P < .01) and children's medication use (85.7% vs 72.6 %; P = .04) during the visit than were parents in the control group, the researchers report in an article published online August 4 in Pediatrics. They also were more likely to have brought their child's medication to the visit (19% vs 10%; P = .19).

In addition, 40% of patients received a PHP-generated alert for watching more than 2 hours a day of television, and 13% of parents agreed to try to reduce television time; 18% of parents screened positive for smoking, and 22% of those parents agreed to call a quit line; 24% of the children had increased risk for tuberculosis, and 75% of those parents said they would remind the physician about tuberculosis screening.

Authors said an automated system can help fill in gaps in care when time is limited in the appointment. They note that 94% of American parents report unmet needs for guidance, education, or screening by pediatric clinicians. "Only 1 in 5 Medicaid-insured children receive adequate preventive services," they write.

"The capacity of clinicians to provide all of the recommended services in the clinical setting has been exceeded," the authors note. "Systems like PHP can enhance adherence to guidelines and improve the availability of needed patient information."

Study participants and clinicians were surveyed after the visits to gauge satisfaction. PHP parents were significantly more likely to report that the intervention reduced their visit time (63% vs 45%; P < .001). PHP parents were also significantly more likely to report feeling "more prepared" for the visit (81% vs 67%; P = .001) than did those in the control group. All of the clinicians in the survey reported that PHP improved the quality of their care.

This work was funded by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online August 4, 2014. Abstract

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