Telephone care to promote self-management and decrease costs

January 01, 0001

Telephone care to promote self-management and decrease costs

These US authors conducted a stratified, randomized study of 174,120 subjects to assess the effect of a telephone-based care-management strategy on medical costs and resource utilization. Health coaches contacted subjects with selected medical conditions and predicted high health care costs to instruct them about shared decision making, self-care, and behavioral change. The subjects were randomly assigned to either a usual-support group or an enhanced-support group. Although the same telephone intervention was delivered to the two groups, a greater number of subjects in the enhanced- support group were made eligible for coaching through the lowering of cutoff points for predicted future costs and expansion of the number of qualifying health conditions.

They found: "At baseline, medical costs and resource utilization were similar in the two groups. After 12 months, 10.4% of the enhanced-support group and 3.7% of the usual-support group received the telephone intervention. The average monthly medical and pharmacy costs per person in the enhanced- support group were 3.6% ($7.96) lower than those in the usual-support group ($213.82 vs. $221.78); a 10.1% reduction in annual hospital admissions (significant) accounted for the majority of savings. The cost of this intervention program was less than $2.00 per person per month."

The authors concluded: "A targeted telephone care-management program was successful in reducing medical costs and hospitalizations in this population-based study."

It is not clear to what extent the strategy was integrated with primary care services.

For the full abstract, click here.

N Engl J Med 363:1245-1255, 23 September 2010
© 2010 to the Massachusetts Medical Society
A Randomized Trial of a Telephone Care-Management Strategy. David E. Wennberg, Amy Marr, Lance Lang, Stephen O'Malley, and George Bennett. Correspondence to Dr. Wennberg: [email protected]

Category: HSR. Health Services Research. Keywords: telephone care, care management, self care, behavioral change, coaching, medical costs, hospitalization, pharmacy, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 19 October 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.