WASHINGTON — Receiving an Internet-based, interactive voice-response call on a mobile phone may help low-income patients in developing countries manage their diabetes, according to a new study led by a researcher with the Veterans Affairs Ann Arbor Healthcare System and University of Michigan.

While interactive voice-response (IVR) calls may improve chronically ill patients’ outcomes, underdeveloped countries often lack the infrastructure to provide these types of services to patients. To address this infrastructure problem, a team lead by John Piette, PhD, a senior research scientist with the VA and professor of internal medicine at the University of Michigan Medical School, sought to test the feasibility of an IVR program using a cloud-computing model. A cloud-computing strategy would allow for the automated phone calls to be generated from a central computer server in Ann Arbor, where the necessary infrastructure is in place.

For the study, Honduran patients with diabetes received IVR calls generated by the central server using VOIP to their cellphones. In total, 85 diabetes patients in Honduras received weekly calls for six weeks, with automated follow-up e-mails to clinicians and voicemail reports to family caregivers.

“At the times that patients said the [call] would be convenient to them, their phone would ring and they would be walked through a 10- to 15-minute series of recorded messages,” said Piette. “They would answer questions by pushing buttons on their phone, and, based on what they said, they would receive specialty tailored information that was important to them. If the patient reported something very serious during that interaction, a structured e-mail or fax alert would be sent directly to their doctor’s office. They could then follow up and prevent very serious or emerging problems with the patient.”

A total of 53% of participants completed at least half of their IVR calls, and 23% of participants completed 80% or more. Mean HbA1c’s decreased from 10.0% at baseline to 8.9% at follow-up. Most participants (92%) said that if the service were available in their clinic, they would use it again.

Piette said the study showed it was possible to deliver mobile health messages to patients across a great distance from servers, using a cloud computing strategy.

“That could have a lot of great benefits for people in poor countries all over the world that haven’t really developed to the point where they can do these things on their own,” he said.

A limitation to the research was that it did not include a control group, so changes in patients’ health or self-care cannot be attributed definitively to the intervention. In addition, 25% of patients were lost to follow-up, and those patients may have been less satisfied with their experience.

While the study did not involve the VA, Piette said the study results show telemedicine research done at the VA has benefits that go far beyond veterans.

“Telemedicine interventions for chronic diseases like diabetes, or hypertension or depression have really been a focus of what we have been doing for the VA,” he said. “Because the VA has invested so much and produced so much knowledge in this area, we are able to take some of that knowledge and say, ‘There are a lot of ways that this could help solve problems for other people that are very far from their source of care, have limited resources and are struggling with chronic disease.’”

Piette said it is a misconception that the most vulnerable patients may be less motivated to use and benefit from mobile health technology.

“What we found again and again in the VA and in this study, is that the patients that have the greatest challenges, the greatest socioeconomic barriers are exactly the ones who are very motivated to do things like this, and they can do things like this,” he said.

The research was funded by the University of Michigan School of Public Health Global Health Summer Internship Program, the Michigan Diabetes Research and Training Center, and the Michigan Institute for Clinical and Health Research. Piette said he conducted the study as part of his position at the University of Michigan.

“A Preliminary Study of a Cloud-Computing Model for Chronic Illness Self-Care Support in an Underdeveloped Country,” American Journal of Preventive Medicine, June 2011.