Substituting clinician-initiated telephone calls for routine clinic visits reduced total clinic visits by 19% (P<0.001) and total hospital days by 28% (P=0.005) over 2 years.
RCT (n=497)
No
Does substituting clinician-initiated telephone calls for some clinic visits reduce medical care utilization without adversely affecting patient health in men aged 54 years or older?
Substituting telephone care for selected clinic visits significantly reduces medical service utilization and expenditures without adversely affecting health status.
Effect estimate: 19% reduction
p-value: p=<0.001
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%, P less than. 001). In addition, telephone-care patients had less medication use (14%, P =. 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.
J Wasson (1992) conducted an RCT in Primary care patients (n=497). Telephone care vs. Usual care was evaluated on Use of medical services (total clinic visits) (19% reduction, p=<0.001). Substituting clinician-initiated telephone calls for routine clinic visits reduced total clinic visits by 19% (P<0.001) and total hospital days by 28% (P=0.005) over 2 years.