Telephone support and adherence in patients with chronic disease – a qualitative review of reviews

Figures & data

Table 1 Search terms

Database	Search terms
CINAHL	(MM “medication compliance/ED/EP/EV/PC/TD”) AND phone AND reviews Search mode: smart text searching Limits: publication dates - 2004 to 2014
PubMed	(((((((phone support) OR SMS) OR messaging)
	OR mobile phone) OR cell phone)) AND (((((adherence) OR compliance) OR concordance)
	OR medication adherence) OR nonadherence)) AND (((((hypertension) OR diabetes) OR (cancer OR neoplasms)) OR (heart failure OR coronary heart disease)) OR obesity) AND (systematic[sb] AND “last 10 years”[PDat])
	Limits: publication dates - 2004 to 2014, article types - meta-analysis and systematic reviews
Cochrane Library	#1 (complian* or comply* or complied or adher* or noncomplian* or nonadher*):ti,ab,kw (word variations have been searched) #2 “phone” or “SMS” or “mobile” or “cell”:ti,ab,kw (word variations have been searched) #3 diabetes #4 cancer #5 heart failure or coronary heart disease #6 hypertension #7 obesity #8 - #3 or #4 or #5 or #6 or #7 #9 - #1 and #2 and #8
	Limits: publication dates - 2004 to 2014, in Cochrane Reviews (reviews only)

Table 2 Reviews remaining after title screening

Study information	Target condition	Number of studies included for review, in which countries	Secondary aims of the review	Criteria taken as measures	Telephone support compared to what other services	More than one disease state studied	Conditions studied
Park LG, Howie-Esquivel J, Dracup K. (2014)^27 Quantitative systematic review. California, USA.	Chronic disease	29-13 in USA, others include Kenya, Cameroon, India	Acceptability and satisfaction of mobile phone interventions; evaluate the rigor, impact, cost and resource feasibility, generalizability, implications for nursing practice and research	Frequency, tracking (two-way messaging) and response rate, message content, and satisfaction reports	Generalized messages versus customized messages	HIV/AIDS (seven), diabetes (six), asthma (three), schizophrenia (two), hypertension (one), general chronic diseases (one), acne (one), atopic dermatitis (one), systematic lupus erythematosus (one), immunosuppression after pediatric liver transplant (one)	Medication adherence
Horvath T, Azman H, Kennedy GE, Rutherford GW. (2015)^25 Meta analysis. University of California, USA.	HIV infection	One ongoing study + two (Kenya)	Extent to which frequency and length of messaging impacts medication adherence – quality of life (emotional and mental state improvement)	Length and Interval of SMS	SMS against standard care	None	Adherence to antiretroviral therapy
Gentry S, van-Velthoven MH, Tudor Car L, Car J. (2013)^26 Narrative synthesis. UK.	HIV infection	11	Generalizability of the study, long-term considerations		SMS against standard care	HIV infection or smoking addiction, and one study focused on children and adolescents	Self-management processes and outcomes, including adherence to treatment plan, medication, or appointments, improvements in clinical or behavioral outcome measures, improvements in processes of care
Jones KR, Lekhak N, Kaewluang N. (2014)^24 Meta review. Ohio, USA.	Chronic disease	11	Patient evaluation outcomes, provider evaluation outcomes, economic outcomes, adverse outcomes regarding the communication mode User evaluation of the intervention, health service utilization and costs, possible risks and harms associated with the intervention	SMS - intervention content, intervention target, frequency of delivery, duration of intervention, who delivered the intervention, number of providers, training for patients and providers, initiator of the intervention, adherence, exposure, quality of delivery, participant responsiveness, mode of delivery, behavior-change theory used, implementation fidelity, program differentiation, security arrangements	Face-to-face consultation or usual care	Not applicable	Medication adherence, immunologic or virologic improvements, risky sexual behavior, depression symptom
de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek v, Car J, Atun R. (2011)^19 Narrative analysis, UK.	Long-term diseases	7	–	SMS - technical specifications on SMS and handset provider, duration of intervention, purpose of intervention, initiator of intervention, message content, details of control/usual or routine care, co-interventions	Usual care and against email in one study	Diabetes, hypertension, asthma, bulimia, HIV infection	Enhance self-efficacy (eg, reminders, feedback on treatment success), provide a form of social support (from peers and health professionals), or establish social networks (support groups, peer-to-peer networks)
Krishna S, Boren SA. (2009)^20 Systematic review, USA.	–	25 studies – four conducted in Australia, three in the United Kingdom; five reports of three studies took place in Korea, two each in New Zealand, Spain, and the United States, one study each in Austria, China, Croatia, Italy, France, Netherlands, Norway	–	Technology (SMS, voice, PDA), delivery frequency, duration	Standard treatment, usual care, paper or diary during visit, verbal advice	Twelve different clinical areas, with nine articles on diabetes, four articles on smoking cessation, two articles each on HIV/AIDS and general outpatient clinics, one article each on asthma, hypertension, physical activity, orthodontics, hepatitis vaccinations, stress management, physical disabilities, health promotion	Behavior change (medication compliance, vaccination compliance, smoking cessation) clinical improvement, social functioning
				Technology (SMS, voice, Internet Email), frequency, content, and delivery, diet and medication compliance, weight, foot care and clinical values, user satisfaction values	Clinical visit or standard care	Diabetes type 1 and type 2	Self management, clinical improvement, health status
Krishna S, Boren SA, Balas EA. (2009)^21 Systematic review. USA.	Diabetes/obesity	18	–	Measuring HbAk levels	Studied as one of the interventions among web-based support, CD-ROMs, computer- based learning and email	Type 2 diabetes	Adherence to physical activity regimens
Clifford S, Perez-Nieves M, Skalicky AM, Reaney M, Coyne KS. (2014)^16 Systematic review, USA.	Diabetes		–	Monitoring of symptoms, medicine management, education and counseling on life-style	Telephone support and telemonitoring evaluated against regular clinic or home visits	Chronic heart failure	All-cause mortality, all-cause rate of hospital admissions, rate of hospital admissions due to heart failure
Connelly J, Kirk A, Masthoff J, MacRury S. (2013)^17 Systematic review, UK.	Diabetes	15	Health related quality of life, health care costs with structured telephone support and acceptability	Communication mode (verbal, written, visual), content (counseling, monitoring, side-effects, social support), reminders, dosing schedules	Long-term telephone interventions versus short-term interventions	Heart failure, asthma, hypertension, diabetes, COPD	Change in adherence with prescribed medications in which both adherence and treatment effects were measured
Clark RA, Inglis SC, McAlister FA, Cleland JG, Stewart S. (2007)^18 Systematic review & meta analysis, Australia.	Chronic heart failure	28	–	Food-based dietary advice • Rationale underlying the dietary advice (eg, clinical practice guidelines, other evidence-based sources) • Adherence assessment method (proportion of clients achieving the dietary advice, biochemical measures) • Description of the intervention (eg, education, persuasion, training)	Measuring dietary changes is the main objective - telephone was one of the interventions used to follow-up	Cardiovascular diseases, diabetes, hypertension, renal diseases, or at least one risk factor for a chronic disease - overweight, hyperlipidemia	Identification of effective behavior change interventions, implementation of evidence- based practice
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. (2008)^7 Qualitative analysis. Canada.	All medical problems, including mental disorders but not addictions	20	Client-based health or behavior outcomes; cost, time, resources required by client, family or nonfamily caregivers or health care professionals; harms or secondary effects (eg, confusion regarding new eating patterns, feelings of lack of confidence or skills in preparing meals, unhappiness at loss of traditional meals)	• Person-independent interventions: electronic systems • Person-dependent interventions: nonautomated phone calls • Person-dependent interventions: in-person meetings	The mechanism of information transfer to patients	Myocardial infarction, coronary heart disease, heart failure hypertension, hyperlipidemia, diabetes	Adherence to cardiovascular medications
Desroches S, Lapointe A, Ratté S, Gravel K, Légaré F, Turcotte S. (2013)^22 Narrative analysis, Canada.	Chronic diseases	38	–
Cutrona SL, Choudhry NK, Fischer MA, et al. (2010)^23 Systematic review, USA.	Cardiovascular disease	51

Abbreviations: COPD, chronic obstructive pulmonary disease; HbA1c, glycated hemoglobin; AIDS, acquired immune deficiency syndrome; HIV, human immunodeficiency virus; OHAs, oral hypoglycemic agents; PDA, personal digital assistant; SMS, short message service.

Figure 1 Flow diagram of review selection (based on PRISMA 2009 Flow Diagram).

Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Table 3 Effectiveness and cost-effectiveness of telephone support

Study information	Review design	PRISMA checklist items reported (out of 27 Items)	Intervention functionality	Adherence measures	Frequency measures	Cost measures	Key findings, as reported in the conclusion section
Park et al (2014)^Citation27	Quantitative systematic review of 29 studies	17 items reported	Mobile phone text messages	Most interventions (18 of 29) were efficacious in improving adherence - the difference in mean adherence rates of cases and controls were significant in 18 studies whereas in the others there was no difference	Reminders - once or twice daily or if dispenser not opened; customized - daily to match dosing frequency	Five studies report a cost-analysis of the intervention-outcome not mentioned	Tailored or personalized message content with additional information about treatment was preferred over repetitious reminder messages
Horvath et al (2012)^Citation25	Meta-analysis of two studies	22 items reported	Mobile phone text messaging	Nonsignificant lowering of risk for nonadherence, compared to controls	Weekly messages more effective than daily messages	Not reported (the extent to which frequency of messages affects adherence rates is also one of our research questions)	Patients receiving weekly text messages of any length were at lower risk for nonadherence compared to those receiving daily messages of any length
Gentry et al (2013)^Citation26	Meta-analysis of six studies and narrative synthesis of eleven studies	23 items reported	Telephone consultation by landline or mobile phone	No significant difference between telephone-delivered interventions and controls; telephone interventions may be able to reduce risky sexual behavior in a middle-aged and older adult population	Reported that frequency of delivery is not clear in the studies	The excess cost of traveling time and expenses for in- person sessions accounted for a difference in the total cost of in-person intervention	There is some weak evidence that telephone interventions may be able to improve medication adherence in PLHIV. It is not clear what type of intervention, if any, is most effective, the frequency of intervention delivery required to improve adherence, or the target population(s) that are most likely to benefit

Abbreviations: PLHIV, people living with human immunodeficiency virus; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Park LG, Howie-Esquivel J, Dracup K. A quantitative systematic review of the efficacy of mobile phone interventions to improve medication adherence. J Adv Nurs. 2014;70(9):1932–1953.

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Horvath T, Azman H, Kennedy GE, Rutherford GW. Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev. 2012;3:CD009756.

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Gentry S, van-Velthoven MH, Tudor Car L, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database Syst Rev. 2013;5:CD009189.

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