This is one article in a series of articles based on a recent UK report about the use of telephones in case management. Click here for an overview of telephonic case management.

In other articles, we have explored the use of telephones for case assessment and triage, as well as to support return to work.

In this article, we look at using the telephone for therapeutic intervention to impart information directly to the patient, and in turn influence the patient/worker/claimant’s behaviours.

Practitioners often struggle to deliver good quality advice to patients. General practice consultations are generally between 10 and 30 minutes. This time is too short to take a history, examine the patient, write a prescription and a certificate, and offer encouragement and support regarding return to work.

Advising the patient about how to manage their long-term condition takes more time.

Exploring other barriers to return to work and working with the patient to identify ways to overcome those barriers takes even more time. As a specialist, I’ll typically spend about an hour and a half dealing with these issues.

What other ways can injured workers get the information that they need? Perhaps through specialist referrals, but the number of specialists able to devote sufficient time to offer advice and clear explanations is small. Pain management clinics may do a better job of this, but many rely on a generic approach and it often takes a long time for patients to get admitted to such programmes.

Studies show that what injured workers need and want are good advice and clear explanations, and access to this information as early in the claims and RTW process as possible.

So, perhaps we should be looking at alternative strategies to ensure injured workers get the information they require in a timely fashion.

The UK review of the use of telephones in case management has found that the phone is an effective means for case managers to deliver advice and information, including instruction related to self-management approaches to RTW.

Use of the telephone is more effective when as an adjunct to other health services, rather than as a stand-alone service. The telephone can be used to provide information, as well as change perceptions and influence beliefs, thereby motivating the worker to follow their RTW plan.

Some of you will recall our webinar with Dr Ross Iles who used motivational interviewing to assist people with back pain, and with very good results. As with the UK research results, Ross was able to work with people by phone and help them achieve their key goals in managing their back problems.

Of course, it is only logical that the information be evidence-based, consistent, and understandable to recipients. The injured workers need to have confidence that the information helps and supports them. It also means that case managers providing this information by phone be well-trained and their sessions subject to monitoring and feedback to ensure that delivery of this service remains at a high standard.

The two evidence statements that follow summarise this area, and have been taken from the review by the UK Department for Work and Pensions titled “Telephonic support to facilitate return to work: what works, how, and when?”

There is adequate evidence that relevant information and advice, including self-management techniques, can be effectively delivered by telephone. Information and advice in a case management context is seen as a necessary, but not sufficient, part of the overall intervention package. Although generally incorporated into the multifaceted case management process, it is capable of having a positive effect in isolation.

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Self-management of common health (and other) problems can be encouraged and enhanced by telephonic contact.

Many private health insurers in Australia have adopted such an approach. If someone is admitted to hospital with a heart attack, the health insurer provides, for example, six telephone coaching sessions to support that person and motivate them to be more active by taking up an exercise regime and improving their diet.

Health insurers have evidence that early intervention using the phone reduces the likelihood of readmission to hospital. The approach helps the patient improve, and at the same time betters the health insurer’s finances by reducing costs associated with managing such cases.

Of course, the person’s treating practitioner needs to be comfortable with the advice the case manager is imparting to their patient. There is still work to be done to ensure integration of approaches.

Patients off work often struggle to get good healthcare, and can become overwhelmed by the complexities of the system they are dealing with.

Isn’t it time we started considering the use of the telephone to support people with work injuries, or other health problems that are keeping them off work?