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OHRI study shows automated telephone system can help in chronic disease management

April 27, 2009

A new study published in the Canadian Medical Association Journal shows that an automated system is just as effective as a human in communicating with thrombosis patients about frequent dosing adjustments required to prevent dangerous blood clots. The study also showed that the automated system was preferred by 77 per cent of patients and it reduced staff workload by 33 per cent. The Ottawa Hospital is now implementing the system throughout its thrombosis clinic.

“Automated telephone systems have become fairly common in health care and other fields, but this is the first study to look at providing therapy instructions without human intervention,” said senior author Dr. Alan Forster. “We are very encouraged by these results and pleased that all our patients will now have an opportunity to benefit from this system.”

Dr. Forster is an internal medicine specialist at The Ottawa Hospital, a scientist at the Ottawa Hospital Research Institute (OHRI) and an associate professor of medicine at the University of Ottawa. He is a leading expert in patient safety and he has worked with Ottawa company Vocantas Inc. for four years to develop the automated system, called an Interactive Voice Response System (IVRS) for various health care applications.

In the current study, Dr. Forster worked with University of Ottawa graduate student Natalie Oake and Dr. Marc Rodger of The Ottawa Hospital’s Thrombosis Program to customize the system for patients with the chronic blood-clotting disorder thrombosis. This condition is diagnosed in more than 500,000 people per year in Canada and the US and it is the third leading cause of cardiovascular death. Treatment with the blood thinner warfarin can greatly reduce the risk of re-developing these clots, but the dose must be adjusted weekly or even several times a week depending on blood test results. Typically, hospital staff spend hundreds of hours per week trying to relay blood test results and medication instructions to patients over the phone.

In the current study, the IVRS was integrated with a computerized decision support system to telephone patients and instruct them on how to adjust their warfarin dose. The system also reminded patients of upcoming appointments, followed-up on missed appointments and asked patients if they wanted to speak with someone from the clinic. It also asked about new prescriptions, so that staff could determine if there might be any drug interactions.

A total of 226 patients participated in the study. The researchers tested patients’ blood over three months while they used the IVRS and compared the results to the data from the previous three months, when the same patients were managed without the IVRS. The results were identical – patients had the optimal blood consistency 80 per cent of the time both with and without the IVRS. No serious blood clots were detected in any patients during the study. When the three month study period was over, 77 per cent of eligible patients opted to continue using the system instead of going back to the direct staff phone calls. This has allowed staff to spend more time on other aspects of thrombosis care, as the IVRS cut workload by 33 per cent.

“The Ottawa Hospital’s Thrombosis Program has developed a number of tools that are now used around the world to manage thrombosis patients and I’m hopeful that this may be another,” said Dr. Marc Rodger, head of The Ottawa Hospital’s Thrombosis Program, senior scientists at OHRI and professor at the University of Ottawa. “Most hospitals are not able to keep their patients in the ideal warfarin dose range 80 per cent of the time, so patients at these hospitals may benefit even more from this automated system.”

Researchers at The Ottawa Hospital are continuing to investigate this technology in the thrombosis clinic and in other settings. Previous studies by Dr. Forster have shown that the IVRS may be effective in monitoring patients after they have been discharged from the hospital, so that potential adverse events can be detected and addressed before they become more serious.

The current research study is published in the April 28th, 2009 edition of the Canadian Medical Association Journal (Oake et al, CMAJ 2009; 180 (9):927-33). None of the authors have a financial interest in the IVRS or in Vocantas Inc. and the company had no role in collecting or analyzing the data. The researchers are thankful for public support from the Ontario Ministry of Health and Long-Term Care, the Ontario Ministry of Research and Innovation and the Heart and Stroke Foundation of Canada.

About the Ottawa Hospital Research Institute
The Ottawa Hospital Research Institute (OHRI) is the research arm of The Ottawa Hospital and is an affiliated institute of the University of Ottawa, closely associated with the University’s Faculties of Medicine and Health Sciences. The OHRI includes more than 1,300 scientists, clinical investigators, graduate students, postdoctoral fellows, and staff conducting research to improve the understanding, prevention, diagnosis and treatment of human disease. www.ohri.ca

Media contact
Jennifer Paterson
Director, Communications and Public Relations
Ottawa Hospital Research Institute
613-798-5555 ext. 19691
jpaterson@ohri.ca