Telephone care as a substitute for routine clinic follow-up

Design. —Randomized trial. Setting. —A primary care clinic. Patients. —Four hundred ninety-seven men aged 54 years or older. Objective. —We examined the hypothesis that substituting clinician-initiated telephone calls (telephone care) for some clinic visits would reduce medical care utilization without adversely affecting patient health. Intervention. —Clinicians were asked to double their recommended interval for face-to-face follow-up and schedule three intervening telephone contacts; for control patients, the follow-up interval recommended by their clinician was unchanged. Main Outcome Measures. —Use of medical services and health status. Results. —During the 2-year follow-up period, 7% of patients withdrew or became unavailable. Telephone-care patients had fewer total clinic visits, scheduled and unscheduled, than usual-care patients (19%, PP=. 006), fewer admissions, and shorter stays in the hospital (28% fewer total hospital days, P=. 005), and 41% fewer intensive care unit days (P=. 03). Estimated total expenditures for telephone care were 28% less per patient for the 2 years (1656, P=. 004). For the subgroup of patients with fair or poor overall health at the beginning of the study (n= 180), savings were somewhat greater (1976, P=. 01). In this subgroup, improvement in physical function from baseline (P=. 02) and a possible reduction in mortality (P=. 06) were also observed. Conclusion. —We conclude that substituting telephone care for selected clinic visits significantly reduces utilization of medical services. For more severely ill patients, the increased contact made possible by telephone care may also improve health status and reduce mortality. (JAMA. 1992;267: 1788-1793)