Automated Monitoring to Detect H1N1 Symptoms Among Urban, Medicaid-Eligible, Pregnant Women: A Community-Partnered Randomized Controlled Trial

Abstract

In response to the H1N1 epidemic, we used community health workers to design and implement a randomized controlled trial to test the efficacy of a new automated call-monitoring system for second and third trimester predominantly Medicaid-eligible pregnant women in an urban free standing birth center to promptly detect symptoms of influenza and assure rapid treatment to prevent adverse outcomes from influenza. Daily automated telephone call to second and third trimester pregnant women asking if the woman experienced flu-like symptoms. Calls continued daily until 38 weeks gestation. A community health worker’s voice was used for the automated call recording. Positive responses triggered an immediate referral to a nurse-midwife for prompt treatment with anti-viral medication. Fifty pregnant participants were randomized into daily-automated call group (n = 26) or health information group (n = 24). The automated call group participants ranged in age from 14 to 36 (mean = 23.5, SD = 6.3), 84.7 % identified their race/ethnicity as African-American Non-Hispanic, and 80.7 % were Medicaid-Eligible. In the automated call group, 11.5 % chose to be immunized against H1N1. The mean percent of patients reached daily was 45.1 % (SD = 3.2 %) and at least once every 3 days was 65.1 % (SD = 3.1 %). One pregnant woman in the automated call group contracted H1N1 influenza and received prompt anti-viral treatment without any serious outcomes. Participation in daily-automated telephone calls did not differ significantly between patients younger than 18 years old versus patients 18 years or older. There was also no difference in participation between patients with parity of 0 versus patients with parity ≥1. Participation in daily telephone calls significantly (alpha ≤0.05) increased when a community health worker provided personal follow-up of non-responsive participants. 93.3 % of surveyed pregnant women, who received automated daily calls, recommended to use a similar daily call system in response to a future health crisis. Automated daily phone calls, designed and produced by community health workers, is a feasible, well received strategy to provide urgent health information to an urban, Medicaid-eligible group of pregnant women, regardless of age or parity.

Appendix

This appendix describes the text of the telephone survey so others can duplicate our study. Figure 2 shows the overview of the system.

Fig. 2

Overview of the telephone survey

The text of the comments within each node is provided in the following:

Start::

Welcome, this is the call system of the Family Health and Birth Center. We will ask one or two questions. Please do not hang up. We have important information to give you

Symptoms::

Do you currently have any flu symptoms? Say yes if you do have flu symptoms, say no if you do not have flu symptoms, and say not sure if you do not know what are the flu symptoms

Bye Positive::

Your midwife needs to see you to make sure that the illness does not harm you or your child. With your permission, I am going to transfer this call to a person who can arrange for you to come in. If you do not want to do so, you can hang up now. Otherwise, stay on the phone while we find someone to set up an appointment for you to see your midwife today

Bye Negative::

Thanks for checking with us. We are glad you do not have flu like symptoms. Take good care of yourself and we will talk again tomorrow. Please remember that this call does not replace the need for your scheduled prenatal visits

Information::

Symptoms of swine flu are like seasonal flu and include fever, cough, sore throat, body aches, headaches, chills and fatigue. Sometimes, the swine flu is accompanied with diarrhea and vomiting