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July 9, 1997, Vol 278, No. 2 >
ARTICLE | July 9, 1997

Electronic Communication With Patients: Title and subTitle BreakEvaluation of Distance Medicine Technology FREE

E. Andrew Balas, MD, PhD; Farah Jaffrey, MSc; Gilad J. Kuperman, MD, PhD; Suzanne Austin Boren, MHA; Gordon D. Brown, PhD; Francesco Pinciroli, LEE; Joyce A. Mitchell, PhD
[+] Author Affiliations

Reprints: E. Andrew Balas, MD, PhD. School of Medicine, University of Missouri—Columbia, 324 Clark Hall. Columbia, MO 65211 (e-mail: E._Andrew_Balas@ muccmail.missouri.edu).


JAMA. 1997;278(2):152-159. doi:10.1001/jama.1997.03550020084043
Text Size: A A A
Published online
Article
References

Objective.  —To evaluate controlled evidence on the efficacy of distance medicine technologies in clinical practice and health care outcome.

Data Sources.  —Systematic electronic database and manual searches (1966-1996) were conducted to identify clinical trial reports on distance medicine applications.

Study Selection.  —Three eligibility criteria were applied: prospective, contemporaneously controlled clinical trial with random assignment of the intervention; electronic distance technology application in the intervention group and no similar intervention in the control group; and measurement of the intervention effect on process or outcome of care.

Data Extraction.  —Data were abstracted by independent reviewers using a standardized abstraction form and the quality of methodology was scored. Distance technology applications were described in 6 categories: computerized communication, telephone follow-up and counseling, telephone reminders, interactive telephone systems, after-hours telephone access, and telephone screening.

Data Synthesis.  —Of 80 eligible clinical trials, 61 (76%) analyzed providerinitiated communication with patients and 50 (63%) reported positive outcome, improved performance, or significant benefits, including studies of computerized communication (7 of 7), telephone follow-up and counseling (20 of 37), telephone reminders (14 of 23), interactive telephone systems (5 of 6), telephone access (3 of 4), and telephone screening (1 of 3). Significantly improved outcomes were demonstrated in studies of preventive care, management of osteoarthritis, cardiac rehabilitation, and diabetes care.

Conclusions.  —Distance medicine technology enables greater continuity of care by improving access and supporting the coordination of activities by a clinician. The benefits of distance technologies in facilitating communication between clinicians and patients indicate that application of telemedicine should not be limited to physician-to-physician communication.

REFERENCES

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Arthur D Little Inc. Telecommunications: Can It Help Solve America's Health Care Problems? Cambridge, Mass: Arthur D Little, Inc; 1992;.
5 +
Lindberg DA, Humphreys BL.  Computers in medicine . JAMA . 1995;;273:1667.
6 +
Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp K, Brown GD.  The clinical value of computerized information services: areview of 98randomized clinical trials . Arch Fam Med . 1996;;5:271-278.
7 +
Balas EA, Stockham MG, Mitchell JA, Austin SM, West DA, Ewigman BG.  The Columbia Registry of Information and Utilization Management Trials . J Am Med Inform Assoc . 1995;;2:307-315.
8 +
Balas EA, Austin SM, Brown GD, Mitchell JA.  Quality evaluation of controlled information service trials . In: Safran C, ed. Proceedings of the Seventeenth Annual Symposium on Computer Applications in Medical Care—October 30 to November 3, 1993 . New York, NY: McGraw-Hill Book Co; 1994;: 586-590.
9 +
Balas EA, Austin SM, Ewigman BG, Brown GD, Mitchell JA.  Methods of randomized controlled clinical trials in health services research . Med Care . 1995;;33:687-699.
10 +
Alemi F, Higley P.  Reaction to 'talking' computers assessing health risks . Med Care . 1995;;33:227-233.
11 +
Schneider SJ, Schwartz MD, Fast J.  Computerized, telephone-based stress management program . In: Safran C, ed. Proceedings of the seventeenth Annual Symposium on Computer Applications in Medical Care—October 30 to November 3, 1993 . New York, NY: McGraw-Hill Book Co; 1993;: 37-40.
12 +
Shultz EK, Bauman A, Hayward M, et al.  Improved diabetic prognosis following telecommunication and graphical processing of diabetic data . In: Clayton PD, ed. Proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care—November 17 to November 20, 1991 . New York, NY: McGraw-Hill Book Co; 1991;:53-57.
13 +
Shultz EK, Bauman A, Hayward M, Holzman R.  Improved care of patients with diabetes through telecommunications . Ann N Y Acad Sci . 1992;;670:141-145.
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Ahring KK, Joyce C, Ahring JPK, Farid NR.  Telephone modem access improves diabetes control in those with insulin-requiring diabetes . Diabetes Care . 1992;;15:971-975.
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Billiard A, Rohmer V, Roques M, et al.  Telematic transmission of computerized blood glucose profiles for IDDM patients . Diabetes Care . 1991;;14:130-134.
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Turnin MG, Beddok RH, Clottes J, et al.  Telematic expert system Diabeto: new tool for diet self-monitoringfor diabetic patients . Diabetes Care . 1992;;15:204-212.
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Sparks KE, Shaw DK, Eddy D, et al.  Alternatives for cardiac rehabilitation patients unable to return to a hospital-based program . Heart Lung . 1993;;22:298-303.
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Brennan PF, Moore SM, Smyth KA.  The effects of a special computer network on caregivers of persons with Alzheimer's disease . Nurs Res . 1995;;44:166-172.
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Nelson EW, Van Cleve S, Swartz MK, Kessen W, McCarthy PL.  Improving the use of early follow-up care after emergency department visits . Am J Dis Child . 1991;;145:440-444.
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Jones SL, Jones PK, Katz J.  Health belief model intervention to increase compliance with emergency department patients . Med Care . 1988;;26:1172-1184.
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Jones PK, Jones SL, Katz J.  A randomized trial to improve compliance in urinary tract infection patients in the emergency department . Ann Emerg Med . 1990;;19:16-20.
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Shesser R, Smith M, Adams S, Walls R, Paxton M.  The effectiveness of an organized emergency department follow-up system . Ann Emerg Med . 1986;;15:911-915.
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Chande VT, Exum V.  Follow-up phone calls after an emergency department visit . Pediatrics . 1994;;93:513-514.
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DeBusk RF, Houston Miller N, Superko R, et al.  A case-management system for coronary risk factor modification after acute myocardial infarction . Ann Intern Med . 1994;;120:721-729.
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Capone RJ,Stablein D, Visco J, et al.  The effects of a transtelephonic surveillance and prehospital emergency intervention system on the 1-year course following acute myocardial infarction . Am Heart J . 1988;;116( (6) , pt 1):1606-1615.
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Gortner SR, Jenkins LS.  Self-efficacy and activity level following cardiac surgery . J Adv Nurs . 1990;;15:1132-1138.
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Beckie T.  A supportive-educative telephone program: impact on knowledge and anxiety after coronary artery bypass graft surgery . Heart Lung . 1989;;18:46-55.
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Lerman C, Hanjani P, Caputo C, et al.  Telephone counseling improves adherence to colposcopy among lower-income minority women . J Clin Oncol . 1992;;10:330-333.
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Rene J, Weinberger M, Mazzuca SA, Brandt KD, Katz BP.  Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable . Arthritis Rheum . 1992;;35:11-15.
34 +
Weinberger M, Tierney WM, Cowper PA, Katz BP, Booher PA.  Cost-effectiveness of increased telephone contact for patients with osteoarthritis: a randomized, controlled trial . Arthritis Rheum . 1993;;36:243-246.
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Swinson RP, Fergus KD, Cox BJ, Wickwire K.  Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia . Behav Res Ther . 1995;;33:465-469.
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Sanmarti SL, Megias AJ, Gomez MNA, et al.  Evaluation of the efficacy of health education on the compliance with antituberculosis chemoprophylaxis in school children: a randomized clinical trial . Tuber Lung Dis . 1993;;74:28-31.
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 Correction : Tuber Lung Dis . 1993;;74:217.
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Oda DS, Fine JI,Heilbron DC.  Impact and cost of public health nurse telephone follow-up of school dental referrals . Am J Public Health . 1986;;76:1348-1349.
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Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG.  Telephone care as a substitute for routine clinic follow-up . JAMA . 1992;;267:1788-1793.
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Elder JP, Wildey M, de Moor C, et al.  The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions . Am J Public Health . 1993;;83:1239-1244.
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Lando HA, Hellerstedt WL, Pirie PL, McGovern PG.  Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation . Am J Public Health . 1992;;82:41-46.
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Ockene JK, Kristeller J, Goldberg R, et al.  Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial . J Gen Intern Med . 1991;;6:1-8.
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Thompson B, Kinne S, Lewis FM, Wooldridge JA.  Randomized telephone smoking-intervention trial initially directed at blue-collar workers . Monogr Natl Cancer Inst . 1993;;14:105-112.
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Weinberger M, Kirkman MS, Samsa GP, et al.  A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life . J Gen Intern Med . 1995;;10:59-66.
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Kirkman MS, Weinberger M, Landsman PB, et al.  A telephone-delivered intervention for patients with NIDDM . Diabetes Care . 1994;;17:840-846.
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Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
US Congress, Office of Technology Assessment. Health Care in Rural America. Washington, DC: US Government Printing Office; 1990. Publication OTA-H-434.
2 +
Perednia DA, Allen A.  Telemedicine technology and clinical applications . JAMA . 1995;;273:483-488.
3 +
Committee on Evaluating Clinical Applications of Telemedicine, Division of Health Care Services, Institute of Medicine. In: Field MJ, ed. Telemedieine: A Guide to Assessing Telecommunications in Health Care . Washington, DC: National Academy Press; 1996;.
4 +
Arthur D Little Inc. Telecommunications: Can It Help Solve America's Health Care Problems? Cambridge, Mass: Arthur D Little, Inc; 1992;.
5 +
Lindberg DA, Humphreys BL.  Computers in medicine . JAMA . 1995;;273:1667.
6 +
Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp K, Brown GD.  The clinical value of computerized information services: areview of 98randomized clinical trials . Arch Fam Med . 1996;;5:271-278.
7 +
Balas EA, Stockham MG, Mitchell JA, Austin SM, West DA, Ewigman BG.  The Columbia Registry of Information and Utilization Management Trials . J Am Med Inform Assoc . 1995;;2:307-315.
8 +
Balas EA, Austin SM, Brown GD, Mitchell JA.  Quality evaluation of controlled information service trials . In: Safran C, ed. Proceedings of the Seventeenth Annual Symposium on Computer Applications in Medical Care—October 30 to November 3, 1993 . New York, NY: McGraw-Hill Book Co; 1994;: 586-590.
9 +
Balas EA, Austin SM, Ewigman BG, Brown GD, Mitchell JA.  Methods of randomized controlled clinical trials in health services research . Med Care . 1995;;33:687-699.
10 +
Alemi F, Higley P.  Reaction to 'talking' computers assessing health risks . Med Care . 1995;;33:227-233.
11 +
Schneider SJ, Schwartz MD, Fast J.  Computerized, telephone-based stress management program . In: Safran C, ed. Proceedings of the seventeenth Annual Symposium on Computer Applications in Medical Care—October 30 to November 3, 1993 . New York, NY: McGraw-Hill Book Co; 1993;: 37-40.
12 +
Shultz EK, Bauman A, Hayward M, et al.  Improved diabetic prognosis following telecommunication and graphical processing of diabetic data . In: Clayton PD, ed. Proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care—November 17 to November 20, 1991 . New York, NY: McGraw-Hill Book Co; 1991;:53-57.
13 +
Shultz EK, Bauman A, Hayward M, Holzman R.  Improved care of patients with diabetes through telecommunications . Ann N Y Acad Sci . 1992;;670:141-145.
14 +
Ahring KK, Joyce C, Ahring JPK, Farid NR.  Telephone modem access improves diabetes control in those with insulin-requiring diabetes . Diabetes Care . 1992;;15:971-975.
15 +
Billiard A, Rohmer V, Roques M, et al.  Telematic transmission of computerized blood glucose profiles for IDDM patients . Diabetes Care . 1991;;14:130-134.
16 +
Turnin MG, Beddok RH, Clottes J, et al.  Telematic expert system Diabeto: new tool for diet self-monitoringfor diabetic patients . Diabetes Care . 1992;;15:204-212.
17 +
Robinson TN.  Community health behavior change through computer network health promotion: preliminary findings from Stanford HealthNet . Comput Methods Prog Biomed . 1989;;30:137-144.
18 +
Sparks KE, Shaw DK, Eddy D, et al.  Alternatives for cardiac rehabilitation patients unable to return to a hospital-based program . Heart Lung . 1993;;22:298-303.
19 +
Brennan PF, Moore SM, Smyth KA.  The effects of a special computer network on caregivers of persons with Alzheimer's disease . Nurs Res . 1995;;44:166-172.
20 +
Nelson EW, Van Cleve S, Swartz MK, Kessen W, McCarthy PL.  Improving the use of early follow-up care after emergency department visits . Am J Dis Child . 1991;;145:440-444.
21 +
Jones SL, Jones PK, Katz J.  Health belief model intervention to increase compliance with emergency department patients . Med Care . 1988;;26:1172-1184.
22 +
Jones PK, Jones SL, Katz J.  A randomized trial to improve compliance in urinary tract infection patients in the emergency department . Ann Emerg Med . 1990;;19:16-20.
23 +
Shesser R, Smith M, Adams S, Walls R, Paxton M.  The effectiveness of an organized emergency department follow-up system . Ann Emerg Med . 1986;;15:911-915.
24 +
Chande VT, Exum V.  Follow-up phone calls after an emergency department visit . Pediatrics . 1994;;93:513-514.
25 +
DeBusk RF, Houston Miller N, Superko R, et al.  A case-management system for coronary risk factor modification after acute myocardial infarction . Ann Intern Med . 1994;;120:721-729.
26 +
Capone RJ,Stablein D, Visco J, et al.  The effects of a transtelephonic surveillance and prehospital emergency intervention system on the 1-year course following acute myocardial infarction . Am Heart J . 1988;;116( (6) , pt 1):1606-1615.
27 +
Gortner SR, Jenkins LS.  Self-efficacy and activity level following cardiac surgery . J Adv Nurs . 1990;;15:1132-1138.
28 +
Beckie T.  A supportive-educative telephone program: impact on knowledge and anxiety after coronary artery bypass graft surgery . Heart Lung . 1989;;18:46-55.
29 +
Mohler PJ.  Enhancing compliance with screening mammography recommendations:a clinical trial in a primary care office . Fam Med . 1995;;27:117-121.
30 +
King ES, Rimer BK, Seay J, Balshem A, Engstrom PF.  Promoting mammography use through progressive interventions:is it effective? Am J Public Health . 1994;;84:104-106.
31 +
Calle EE, Moss RE, Miracle-McMahill HL, Heath CW Jr.  Personal contact from friends to increase mammography usage . Am J Prev Med . 1994;;10:361-366.
32 +
Lerman C, Hanjani P, Caputo C, et al.  Telephone counseling improves adherence to colposcopy among lower-income minority women . J Clin Oncol . 1992;;10:330-333.
33 +
Rene J, Weinberger M, Mazzuca SA, Brandt KD, Katz BP.  Reduction of joint pain in patients with knee osteoarthritis who have received monthly telephone calls from lay personnel and whose medical treatment regimens have remained stable . Arthritis Rheum . 1992;;35:11-15.
34 +
Weinberger M, Tierney WM, Cowper PA, Katz BP, Booher PA.  Cost-effectiveness of increased telephone contact for patients with osteoarthritis: a randomized, controlled trial . Arthritis Rheum . 1993;;36:243-246.
35 +
Swinson RP, Fergus KD, Cox BJ, Wickwire K.  Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia . Behav Res Ther . 1995;;33:465-469.
36 +
Sanmarti SL, Megias AJ, Gomez MNA, et al.  Evaluation of the efficacy of health education on the compliance with antituberculosis chemoprophylaxis in school children: a randomized clinical trial . Tuber Lung Dis . 1993;;74:28-31.
37 +
 Correction : Tuber Lung Dis . 1993;;74:217.
38 +
Oda DS, Fine JI,Heilbron DC.  Impact and cost of public health nurse telephone follow-up of school dental referrals . Am J Public Health . 1986;;76:1348-1349.
39 +
Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG.  Telephone care as a substitute for routine clinic follow-up . JAMA . 1992;;267:1788-1793.
40 +
Elder JP, Wildey M, de Moor C, et al.  The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions . Am J Public Health . 1993;;83:1239-1244.
41 +
Lando HA, Hellerstedt WL, Pirie PL, McGovern PG.  Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation . Am J Public Health . 1992;;82:41-46.
42 +
Ockene JK, Kristeller J, Goldberg R, et al.  Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial . J Gen Intern Med . 1991;;6:1-8.
43 +
Thompson B, Kinne S, Lewis FM, Wooldridge JA.  Randomized telephone smoking-intervention trial initially directed at blue-collar workers . Monogr Natl Cancer Inst . 1993;;14:105-112.
44 +
Weinberger M, Kirkman MS, Samsa GP, et al.  A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life . J Gen Intern Med . 1995;;10:59-66.
45 +
Kirkman MS, Weinberger M, Landsman PB, et al.  A telephone-delivered intervention for patients with NIDDM . Diabetes Care . 1994;;17:840-846.
46 +
Fretwell MD, Raymond PM, McGarvey ST, et al.  The Senior Care Study: a controlled trial of a consultative/unit-based geriatric assessment program in acute care . J Am Geriatr Soc . 1990;;38:1073-1081.
47 +
Infante-Rivard C, Krieger M, Petitclerc M, Baumgarten M.  A telephone support service to reduce medical care use among the elderly . J Am Geriatr Soc . 1988;;36:306-311.
48 +
Goodman C.  Evaluation of a model self-help telephone program: impact on natural networks . Soc Work . 1990;;35:556-562.
49 +
Bryce RL, Stanley FJ, Garner JB.  Randomized controlled trial of antenatal social support to prevent preterm birth . Br J Obstet Gynaecol . 1991;;98:1001-1008.
50 +
Hagopian GA, Rubenstein JH.  Effects of telephone call interventions on patients' well-being in a radiation therapy department . Cancer Nurs . 1990;;13:339-344.
51 +
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52 +
Fletcher EC, Luckett RA.  The effect of positive reinforcement on hourly compliance in nasal continuous positive airway pressure users with obstructive sleep apnea . Am Rev Respir Dis . 1991;;143:936-941.
53 +
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54 +
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55 +
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56 +
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57 +
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58 +
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Cummings KM, Frisof KB, Demers P, Walsh D.  An appointment reminder system's effect on reducing the number of hypertension patients who drop out from care . Am J Prev Med . 1985;;1:54-60.
65 +
Brimberry R.  Vaccination of high-risk patients for influenza: a comparison of telephone and mailed reminder methods . J Fam Pract . 1988;;26:397-400.
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68 +
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Simkins CV, Wenzloff NJ.  Evaluation of a computerized reminder system in the enhancement of patient medication refill compliance . Drug Intell Clin Pharm . 1986;;20:799-802.
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Rosser WW, McDowell I, Newell C.  Use of reminders for preventive procedures in family medicine . Can Med Assoc J . 1991;;145:807-812.
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Thompson RS, Michnich ME, Gray J, Friedlander L, Gilson B.  Maximizing compliance with Hemoccult screening for colon cancer in clinical practice . Med Care . 1986;;24:904-914.
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Richardson A, Williams S, Elwood M, Bahr M, Medlicott T.  Participation in breast cancer screening: randomized controlled trials of doctors' letters and of telephone reminders . Aust J Public Health . 1994;;18:290-292.
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Mayer JA, Freseriksen LW.  Encouraging long-term compliance with breast self-examination: the evaluation of prompting strategies . J Behav Med . 1986;;9:179-189.
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McDowell I, Newell C, Rosser W.  Computerized reminders to encourage cervical screening in family practice . J Fam Pract . 1989;;28:420-424.
77 +
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Kluger MP, Karras A.  Strategies for reducing missed initial appointments in a community mental health center . Community Ment Health J . 1983;;19:137-142.
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McDowell I, Newell C, Rosser W.  A randomized trial of computerized reminders for blood pressure screening in primary care . Med Care . 1989;;27:297-305.
80 +
Rosser WW, Hutchison BG, McDowell I, Newell C.  Use of reminders to increase compliance with tetanus booster vaccination . Can Med Assoc J . 1992;;146:911-917.
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83 +
Goodman CC, Pynoos J.  A model telephone information and support program for caregivers of Alzheimer's disease . Gerontologist . 1990;;30:399-404.
84 +
Heather N, Kisson-Singh J, Fenton GW.  Assisted natural recovery from alcohol problems: effects of a self-help manual with and without supplementary telephone contact . Br J Addict . 1990;;85:1177-1185.
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Linkins RW, Dini EF, Watson G, Patriarca PA.  A randomized trial of the effectiveness of computergenerated telephone messages in increasing immunization visits among preschool children . Arch Pediatr Adolesc Med . 1994;;148:908-914.
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To understand the clinical management of acute heart failure syndromes.
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Compression-Only CPR: Pushing the Science Forward
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AAM 2010;304:1493-1495.
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BMJ 2010;341:c5893-c1494.
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