Determinants of Medical Care Utilization: The Role of the Telephone in Total Medical Care

The importance of the telephone in the American medical care system is only beginning to receive appropriate attention. Fast studies indicate that a significant proportion of new diseases and a significant proportion of all medical care contacts take place by phone. A study of telephone use in a prepaid group practice system is presented. Data on telephone utilization are analyzed to determine the significance of telephone utilization of the population and to identify the patterns of telephone calls within total care seeking behavior. The purpose is to determine alternative modes of dealing with problems presented by phone or at least to assure that this important aspect of care is integrated into medical care. Telephone calls represented a significant proportion of the total medical care of the study population. About 50 per cent of all phone calls to medical core personnel were concerning symptoms of disease and approximately 40 per cent concerned laboratory results or prescriptions. Factors affecting the disposition of symptom phone calls were analyzed. It was hypothesized that the relative probability of a patient being told to come to the clinic after discussing a symptom would vary inversely with the certainty of the physician in his diagnosis and directly with the seriousness of the disease as perceived by the physician. The inferences from the data generally tended to support the hypotheses. These tendencies, however, were not strong enough to accurately predict when the physician would only discuss the symptom, give a prescription, or request a patient to visit. The concepts do not yet lend themselves to operational decision models for use by personnel trained to handle these kinds of calls, because of tremendous individual variation among physicians that confounds attempts to predict the disposition of symptom phone calls using only patient, disease, and situational variables.