The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis

Caroline Free, Gemma Phillips, Louise Watson, Leandro Galli, Lambert Felix, Phil Edwards, Vikram Patel, Andy Haines, Caroline Free, Gemma Phillips, Louise Watson, Leandro Galli, Lambert Felix, Phil Edwards, Vikram Patel, Andy Haines

Abstract

Background: Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes.

Methods and findings: We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05-1.07, I(2) = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature.

Conclusions: The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed. Please see later in the article for the Editors' Summary.

Conflict of interest statement

VP is a member of the Editorial Board of PLOS Medicine. The authors have declared that no other competing interests exist.

Figures

Figure 1
Figure 1
PRISMA 2009 flow diagram.
Figure 2
Figure 2
Cochrane summary risk of bias for trials of health care provider support interventions (n = 32).
Figure 3
Figure 3
Cochrane summary risk of bias for trials of health services support (n = 10).
Figure 4
Figure 4
Forest plots of the effect of SMS reminders on appointments.

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