Regarding: “Access to Mobile Communication Technology and Willingness to Participate in Automated Telemedicine Calls Among Chronically Ill Patients in Honduras”

Dear Editors:

We read the article written by Piette et al. ¹ published in this journal with interest. We propose some main reasons that might have an effect on some of the results obtained.

First they have pointed that:

we surveyed chronically ill patients with low incomes in Honduras to measure their use of mobile technologies and willingness to participate in mobile disease management support. Most patients (>80%) reported that they would be willing to receive automated calls focused on appointment reminders, medication adherence, health status monitoring, and self-care education. Patients were more likely to be willing to participate in automated telemedicine services if they had to cancel a clinic appointment due to transportation problems or forego medication due to cost pressures.

It is important in healthcare issues that we consider both the quality of the care and the costs of it. In particular, people who live in impoverished areas are much more sensitive to these financial issues. So when the patients were asked to call for their healthcare procedure, presumably this way is very desirable for them because travel costs to go to the healthcare centers are more than the cost of the telephone call, as well as problems related to travel for clinic appoinment. In other words, without this survey obtaining these results is predictable. ²

There is a significant point in these kinds of surveys as reported by Jones et al. ³ that such system “will be trialed in a number of clinical settings including epilepsy management and management of chronic pain.” This research is still in the developmental phases and needs much harmonization to the health system. ³

In this survey there was no specific design for the consultative method with these diseases. ² This study mentioned just chronic diseases, while a self-care education program for each chronic disease already had been designed. Therefore, any specific telephone care method for the patients who had different needs according to the type and the stage of their diseases has not been predicted. ²

There is a bias in this question: “Respondents also were asked: ‘Would you be willing to receive telephone messages previously recorded by a clinician to’” as a prompt about the following services: “remind you about upcoming appointments,” “give you advice about your use of medications,” “help your physicians monitor your symptoms,” and “give you information about your diseases and how you can manage your self-care better.”

The patients were not being questioned about whether you would prefer the telephone care or directive care; rather, the question is designed with the interpretation would you be willing to receive telephone messages previously recorded by a clinician to give you advice about your use of medications and help your physicians monitor your symptoms? It directs a person what to say. ⁴

References

1 Piette JD , Mendoza-Avelares MO , Milton EC , Lange I , Fajardo R . Access to mobile communication technology and willingness to participate in automated telemedicine calls among chronically ill patients in Honduras. Telemed J E Health, 2010; 16:1030–1041. a-0 2 Bowling A , Ebrahim S . Handbook of health research methods, investigation, measurement and analysis. Milton Keynes, UK: Open University Press, 2005. a-1a-4a-5 3 Jones V , Rensink A , Brinksma E . Modelling mobile health systems: An application of augmented MDA for the extended healthcare enterprise. Ninth IEEE International EDOC Enterprise Computing Conference, 2005, September 19–23, 2005. Enschede, The Netherlands. Piscataway, NJ: IEEE, 2005; 58–69. a-2a-3 4 Alvani SM , Azar A , Danaeefard H . Quantitative research methodology in management: A comprehensive approach. Tehran: Eshraghi Press, 2007. a-6

Response to Fayaz‐Bakhsh and Golmohamadi

The authors were invited to respond but chose not to.