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Diabetes education is rapidly being transformed by the burgeoning number of interactive communication technologies. Many novel educational resources have the potential to increase the effectiveness of behavior change interventions and bring diabetes education to patients who traditionally have been underserved. Hightech companies are entering this new market in droves, and they vary in the extent to which patient educators participate in their system design. Moreover, the products and services that vendors offer vary in both price and functionality. To make sense of what is available, it is important that diabetes educators and other clinicians have a clear picture of what interactive health resources could do for them, what factors limit these systems' potential usefulness, and what features to look for when evaluating whether to incorporate a particular technology into patient care.
Interactive educational resources fall into three categories. Some technologies are designed to improve the effectiveness of care during face-toface clinical encounters. For example, computer kiosks have been developed for clinic waiting rooms to evaluate patients' self-care so that diabetes educators can address patients' needs more effectively. Other technologies are designed to improve patients' ability to manage their diabetes independent of interactions with their health care team. Hand-held computers for assisting patients in adjusting their insulin fall into this category, as do diabetes-relevant video games and PCbased home learning tools. The third type of computer application includes technologies that are designed to improve patient-provider communication between face-to-face clinical encounters under the assumption that this may be one of the more effective mechanisms for improving self-care and health outcomes.
I focus here on this last category of interactive technologies-in particular, on systems that use automated telephone calls to enhance the link between diabetes educators and patients. Using these systems, patients can receive recorded educational messages, ask questions of health care providers via voicemail, and report health and self-care problems using their touch-tone telephone keypad. Because some of the routine assessment and information delivery is done via computerized calls, there are fewer demands on educators' time, leaving them free to focus their attention on patients who need them the most. Systems such as these, which augment interactions between patients and educators with communication between patients and automated messaging systems, are often referred to as Automated Telephone Disease...