title: The feasibility of automated voice messaging as an adjunct to diabetes outpatient care.
abstract: OBJECTIVE
  To determine whether automated voice messaging (AVM) systems could be used as an adjunct to primary care for diabetic patients, we examined whether patients were able to respond to AVM queries for clinical information, whether sufficient numbers of problems were identified to warrant the implementation of the service, and whether patients found the system helpful.
  
  
  METHODS
  The AVM system we examined uses specialized computer technology to telephone patients, communicate messages, and collect information. Sixty-five diabetic patients participated. Based on a review of the literature and the input of diabetes clinician-researchers, we developed an AVM monitoring protocol to inquire about patients' symptoms, glucose monitoring, foot care, diet, and medication adherence. Patients also were given the option to listen to health promotion messages and to report their satisfaction with the calls. Patients responded by using their touch-tone telephone keypads.
  
  
  RESULTS
  A total of 216 AVM calls were successfully completed, an average of 3.3 out of four calls per patient. Patients reported a variety of health problems that signaled the need for follow-up. Many patients reported not checking their blood glucose or their feet, and one in four reported problems with medication and diet adherence. Health and self-care problems varied across patient subgroups in ways suggesting that the AVM reports were reliable and valid. Overall, 98% of all patients reported that the calls were helpful, 98% reported that they had no difficulty responding to the calls, and 77% reported that receiving AVM calls would make them more satisfied with their health care.
  
  
  CONCLUSIONS
  This study demonstrates that diabetic patients can respond to AVM queries and find the calls helpful. Such calls are a feasible strategy for identifying health and self-care problems that would otherwise go unnoticed by clinicians.
authors.affiliation: Center for Health Care Evaluation/Health Services Research & Development Field Program, Veterans Affairs Palo Alto Health Care System, Menlo Park 94025, USA. piette@odd.stanford.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Piette
authors.forename: C A
authors.initials: CA
authors.lastname: Mah
mesh_terms: D000368:Aged; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy; D004651:Employment; D005006:Ethnicity; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010045:Outpatients; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012648:Self Care; D017216:Telemedicine / Q000379:methods*
chemical_list: D007328:Insulin