This is one of a series of articles on the use of telephone for case management, based on a recent UK report. Click here for an overview of telephonic case management.

There is robust evidence from numerous sources that telephonic methods can be used to assess the clinical and work participation needs of people with common health problems.  And that use of the telephone can be as effective as face-to-face approaches.

Common health problems include everyday musculoskeletal conditions, and mild to moderate mental health problems. The evidence is stronger for musculoskeletal problems, largely because there has been more research done in this area.

In the life of a work injury or absence from work, early identification of the issues can occur at the:

• Initial report of injury
• Initial claim lodgement
• Initial referral to rehabilitation

We have explored in detail early reporting of injury methods. Verbal reporting of an injury allows collection of relevant information, a personal approach, and early discussions about return to work, as well as referral to appropriate services. Verbal reporting by telephone provides flexibility. The report can be made to someone not on site, which allows efficiency, flexibility and streamlines the process.

Initial claim lodgement may require written information, but an early telephone call provides a rich opportunity to establish connections, discuss relevant issues, identify high risk cases, and triage.

Key elements of effective telephonic assessment and triage:

• The UK review indicates a semistructured interview needs to be tailored to the health condition, such as musculoskeletal versus mental health. A template can be developed, to cover the key areas that need to be discussed and ensure that important information is not missed.
• Allocation of time for calls needs to be considered. Typically mental health problems may require a longer period of time. Some systems allocate 20 minutes for an average call.
• While assessments they follow a semistructured interview, planning the next steps will depend on the nature of the matter being dealt with. Triage starts with determining the priority of needs based on urgency, complexity and severity. It also includes the next step of allocating people to various services, such as coordinating early medical appointment, offering psychological counselling services, or arranging a worksite evaluation.
• The training and skills of the person dealing with the assessment and triage telephone call is important. The available studies indicate the person does not need to be clinically trained, but does require adequate training in use of the telephone, and the assessment and triaging protocols.
• Quality needs to be reviewed, and feedback provided to case managers where appropriate.

Case studies

Case studies were used to highlight what could be achieved with early assessment and triage.

A UK health unit

In the United Kingdom employees are not covered by workers compensation as a wage replacement. All health problems are dealt with under sickness absence.

In 2008 in the Lanarkshire National Health Service department implemented a telephone based work absence system. The aim of the system was to supplement existing policies. 

Non-clinical staff handled calls. On the day the employee was absent a case manager called the employee to offer support, and to assess whether anything could be done to assist. A follow-up phone call on day three occurred, and if the worker was still absent after 10 days they were referred to the occupational health unit.

Staff could be given practical advice over the phone, and were able to self-refer to physiotherapy and counselling services if they wished.

More complex support could be provided through the occupational health unit.

The system resulted in gradual reduction in work absence, and those who were phoned on the first day of absence were more likely to return to work than others in subsequent days. Employees who were called reported a high level of satisfaction.

Those who evaluated this system indicated it was a cost-effective approach.

There has been a commonly held belief that early intervention of all cases may not be efficient, as a large number of individuals are called who do not necessarily need any assistance and will return to work no matter what is done. The reviewers of this system indicated that despite dealing with a large number of people the approach was cost-effective, with a return on investment of 1.14:1.

A commercial insurer

Swiss Re, a major provider of income protection, introduced a system for mild to moderate mental ill-health income protection claims. An initial telephone triage with a mental health clinician occurred.

After an assessment the individual with a mental health problem was offered education, guided self-help, and was signposted to other appropriate services. That is, after assessment triage occurred, with a stepped level of intervention depending upon the individual's needs.

An offer of telephone ongoing case management was provided.

The system was found to be cost-effective, taking into account the intervention costs versus the average length of claim reduction.

Other fields

The report notes telephone assessment and triage has been used in a variety of areas. Research studies have occurred in the management of workplace injuries, assessment and triage of people with chronic pain, anaesthetic assessments before surgery, physiotherapy advice, and mental health referrals.

Conclusion

While not all studies have found good results from telephonic assessment and triage, the majority did report positive benefits. Key elements appear to be appropriate training and skills of staff, as well as an approach that is about supporting the individual, rather than simply assessing and monitoring and trying to limit benefits.