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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

P Sutcliffe, S Martin, J Sturt, J Powell, F Griffiths, A Adams, and J Dale.

Review published: 2011.

CRD summary

The review concluded that communication technologies may increase the frequency of contact between patient and health care professional, but effects on clinical outcomes were unclear. Given the heterogeneous evidence base and limitations in quality, the authors' conclusions are appropriately tentative.

Authors' objectives

To assess the effectiveness and impact of communication technologies for the health care needs, support and education of young people with diabetes.

Searching

MEDLINE, EMBASE, ASSIA, Sociological Abstracts, Social Studies Abstracts, PsycINFO, The Cochrane Library, Dissertation Abstracts and Current Controlled Trials databases were searched from January 1990 to May 2009. There were no language restrictions. Search terms were reported. Public and personal networks and the Internet were searched to identify other studies and grey literature.

Study selection

Studies (of any type of design) of young people and adolescents (mean/median age <25 years) with diabetes (type 1 or 2) were eligible. Studies were required to be based in the community or primary care, consider in-patients or outpatients and to use technologies for communication between patient and clinician. Studies of communication between parent and child, peer to peer or interventions without feedback were excluded.

In the included studies, the mean age of participants was 15.9 years and the mean male proportion was 60%, where reported. Participants mostly had type 1 diabetes. Communication technologies included video conferencing alone or combined with teleconferencing, mobile telephony and short message service (text), telephone support, novel electronic communication devices and web-based discussion boards. Outcomes included blood glucose, HbA1c levels, behavioural and psychosocial outcomes, self care and cost outcomes and frequency of contact. Studies varied in duration from six to 18 months, where reported. Studies were in UK, Australia, USA, France, Austria, Italy, Denmark and Germany.

Two reviewers screened a random sample of 20% of the search results by examining the titles and abstracts. Disagreements were resolved by discussion. The other 80% of papers were split equally and screened by the two reviewers. All full papers were double screened.

Assessment of study quality

Studies were assessed for quality using the Downs and Black 27-item checklist and composite scores (maximum score=28) were calculated. Criteria included quality of reporting, internal validity, power and external validity.

The authors did not state how many reviewers performed the quality assessment.

Data extraction

Data were extracted on the mean HbA1c and mean blood glucose changes, behavioural and psychosocial outcomes (such as quality of life, self efficacy, problem solving and patient-caregiver interaction), self care and cost outcomes (such as cost reduction, improvements in self care, training and satisfaction) and frequency of contact according to how these were measured in the individual studies.

Where data were missing, study authors were contacted for clarification.

One reviewer carried out data extraction, which was checked for accuracy by a second reviewer.

Methods of synthesis

The results of the studies were combined in a narrative synthesis. Results were presented by outcome according to whether study designs were randomised controlled trials (RCTs) or uncontrolled studies.

Results of the review

Nineteen studies (1,064 participants) were included in the review: 10 RCTs and nine uncontrolled studies (case series, case studies, observational and qualitative studies). Composite scores on the Downs and Black checklist ranged from 2 to 25 (median 15).

Clinical outcomes: Two of 10 RCTs found significantly reduced HbA1c levels with novel electronic communication and text messaging compared to control. Improvements from baseline in HbA1c levels were found in five non RCTs, but whether they were significant or not was not reported. There was also improvement in glycaemic control in some studies, but figures were not reported.

Behavioural and psychosocial outcomes: There was limited improvement in some individual outcomes such as quality of life and patient-caregiver interaction, but no quantitative figures were reported.

Self care outcomes: Two RCTs reported improvements in self care, two studies reported improvements in usability and satisfaction and seven studies noted successful metabolic data transmission; it was not reported whether results were consistent among all studies that measured these outcomes.

Frequency of contact: Fifteen out of 19 studies reported an increased frequency of contact between patient and health care professional, but only a proportion of these compared frequency of contact between intervention and control and for some studies this was a requirement of the intervention. Five studies found no evidence of a difference in frequency of contact with communication technologies.

Cost information

Two RCTs found that costs were significantly reduced with communication technologies; the number of studies that measured this outcome was not reported.

Authors' conclusions

Communication technologies may increase the frequency of contact between patient and health care professional. Effects on clinical outcomes were unclear.

CRD commentary

The review addressed a clear but broad research question. Inclusion criteria were appropriate. The comprehensive search strategy was designed to capture studies of all long-term conditions in young people and restriction to diabetes was only undertaken during the selection process, so it was unlikely that studies were missed. The absence of language restriction and inclusion of trial registers and other sources made publication and language biases unlikely. Efforts were clearly made to minimise errors and bias during study selection and data extraction, but not quality assessment. Quality assessment criteria were appropriate. Studies of different study designs varied widely in quality and for at least half of the included studies results were based on changes from baseline rather than comparison with control. There were insufficient studies to compare the effectiveness of different types of communication technologies and inclusion of uncontrolled studies meany that reported changes in outcomes may have been confounded by factors other than the intervention instead of true improvements. Given the heterogeneity in study designs, interventions, participants and outcomes, the decision to combine the studies in a narrative synthesis was appropriate.

The authors' conclusions were appropriately tentative, because of the heterogeneous evidence base and limitations in study quality.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that more research was needed on the effectiveness, cost effectiveness and acceptability of and satisfaction with communication technologies. Such research should focus on a wider population of young people with reasonably well-controlled diabetes to enhance generalisability and should also consider the attitudes of young people towards the involvement of their parents and carers. Studies should assess training needs of patients and providers and impact of implementation of the technologies on organisational changes.

Funding

Warwick and Coventry Primary Care Research, UK.

Bibliographic details

Sutcliffe P, Martin S, Sturt J, Powell J, Griffiths F, Adams A, Dale J. Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare. BMC Endocrine Disorders 2011; 11(1) [PMC free article: PMC3024230] [PubMed: 21210964]

Indexing Status

Subject indexing assigned by CRD

MeSH

Adolescent; Adult; Cell Phones; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Health Services Accessibility; Humans; Internet; Public Health; Telecommunications; Telemedicine; Young Adult

AccessionNumber

12011001352

Database entry date

30/01/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21210964

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