New Windows and Doors Sir?

Telephone outreach is more than a sales pitch. Dr Ian Banks discusses how we can use the telephone to the patient’s health advantage.

Ever lifted the ringing phone just as you’re about to sit down to dinner, only to hear the rants of a mechanical sales person extolling the virtues of the latest in uPVC? It’s called direct telephone marketing and does nothing for Alexander Bell’s reputation or the population’s stress levels for that matter. Yet, if we exclude the semaphore which at least addresses adult inactivity, telephones provide the best way for people to communicate at a distance.

Can we utilise telephones to our patient’s health advantage? We certainly need some help with the world’s ageing population, with a growing number of patients suffering from Long Term Conditions (LTCs) and up to 80 per cent of all GP consultations in the UK relating to LTCs. If you consider that up to 60 per cent of hospital bed days are a direct or indirect result of patients suffering from one or more LTCs, then we’ll need a whole new strategy if we are to make a dent in the ever growing national bill for treating these patients.

In any aged population there are patient co-morbidities requiring specific case management. It’s not uncommon for patients with more than one co-morbid condition to be referred to different healthcare specialists, often leading to continuity (or in fact discontinuity) of care, increased and unnecessary GP visits and costly, preventable hospital admissions. In the UK, 10 per cent of patients account for 55 per cent of hospital bed stays and many of these have LTCs.

One way forward that is starting to gain mileage is through structured LTC management programs. Simple measures such as the use of telephone outreach can dramatically encourage LTC patients to manage their own condition more effectively. Imagine having your own personal mentor and coach to help you through the difficult periods when your motivation wanes. Imagine receiving support from someone who is not only interested in whether you have been taking your meds and eating the right foods, but is also in tune with how your life has changed and how to cope with those changes. This may help decrease hospital admission rates of hard to reach groups, such as men, which are up to twice that of women over the age of 55 years.

But will they keep the draught out?

But does something as simple as using the telephone to maintain regular communication with these patients really work? Well, in short, it seems to. A recent review published in the British Medical Journal (BMJ, May 2007; 334: 942) found that structured telephone support or telemonitoring by a health professional reduced admissions to hospital for chronic heart failure and deaths from all causes by nearly one fifth. It also improved health related quality of life.

The researchers from Australia and Canada looked at a number of random, controlled trials of remote monitoring of patients with chronic heart failure managed in the community. Of the four trials that looked at economic costs and benefits of remote monitoring, three reported reduced cost.

The researchers attributed the reduction in hospital admissions to early intervention by telemonitoring nurses at the first sign of clinical deterioration. They said telemonitoring might lead to shorter hospital stays for all causes rather than fewer admissions as a result of early detection of problems and the support available on discharge.

The researchers said remote monitoring should not be seen as a treatment but a different way of organising effective care alongside specialist care and multidisciplinary heart failure clinics.

Finger wagging versus outreach

It’s pointless criticising those patients who are not aware of the best methods for managing their conditions. The sad fact is we are not generally good at either promoting better self-care and management or better use of health care services. We tend to treat on demand rather than prevent demand and this situation will become increasingly untenable as the inevitable tide of LTCs hits general practice.

Instead, by putting patients at the centre of their care in an environment where healthcare professionals are working alongside social care, their experience is improved, resulting in improved quality of life and reducing the number of in-patient admissions. Better use of available services not only allows pharmacists, for instance, to make better use of their training, experience and changes in their contract, but also allows patients to take control of their medical condition. All of this is good news for the health economy, health professionals, carers and patients.

By combining continuity of contact with a healthcare professional offering advice on a regular basis and making better use of allied specialists’ time, LTC management through telephone outreach is a cost effective and useful way to help improve concordance and self care for many patients. As benefits are both measurable and proven you might ask why this innovation is not adopted more often for the management of patients with long term medical conditions. It needn’t be a one way consultation or sales pitch – it’s all about engaging the patient and putting them at the centre of their own care.

Dr. Banks is an A&E physician in Northern Ireland. He is also chairman of the Men’s Health Forum, President of the European Men’s Health Forum.

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