Telephone coaching: for people with chronic diseases
Hong Kong research conducted by Jennifer Y F Wu et al. and published in the British Medical Journal looked at 502 non-compliant patients taking five or more drugs for chronic diseases. 60 patients dropped out of the study and the remaining participants were randomly divided into a control group and intervention group.
The intervention group received a phone call from a pharmacist in between their hospital appointments (between 2 and 4 months apart). The calls lasted for 10 to 15 minutes. The calls may have triggered more general discussions around the patient’s health and led to greater awareness and proactive attitudes towards health.
After adjusting for variables, the researchers found that telephone counselling was associated with a 41% reduction in the risk of death.
A review by Clark et al suggests that through monitoring of patient health via telephone counselling, hospital admissions were reduced. Furthermore, it reduced the length of stays and the subsequent health costs, as well as having positive effects on clinical outcomes.
The research certainly suggests that telephone counselling is worth exploring further.
The benefits of providing telephone counselling for people with chronic health issues include:
- Through speaking to people on helplines, patients may be guided towards more suitable forms of ongoing help, or be provided with information which removes the necessity for additional help.
- Psychosocial interventions may be provided as part of the approach. An example of this might be the use of psychosocial interventions to promote smoking abstinence in patients with coronary heart disease.
- It can be used as a means of follow-up, and may be used as an extension for or substitute for traditional in- and out-patient care or GP visits. It can also assist in identifying patients in need of a face to face review, thereby allowing for appropriate and effective use of resources.
- It helps patients with the self-management of their health issues. In cases of chronic disease, various effective treatments are available through self-management (such as adherence to medication, blood monitoring, or medical screening attendance), however only about 50% of patients effectively self-manage. Telephone coaching can help.
Other benefits include:
- The availability of services may extend beyond standard working hours where needed.
- It helps patients living in geographically diverse areas and people who find travelling difficult.
- It’s more convenient for both the patients and practitioners.
- It provides a greater sense of anonymity.
- Some people feel more comfortable in their own home rather than in consulting rooms.
Chronic health issues may have mental health effects. Where this occurs:
- Telephone contact has been found to have psychological advantages over face to face contact, particularly in mental health, as it doesn’t require the same cost, stress or time commitment. It also increases adherence to drug treatments and behavioural recommendations.
- Some people may simply need someone to talk to. A help line consultant may provide the emotional support needed, thereby reducing the pressure on other agencies.
Disadvantages:
- There is minimal non-verbal communication, and therefore a chance of miscommunication.
TRAINING
Appropriate training for telephone consultants is required, with a clear triage system should be in place. It is highly advisable for calls to be documented, perhaps on a standardised form. Quality and safety should be closely monitored and evaluated to ensure high quality patient care.
In addition:
- The counselling needs to be clearly structured and based on established behaviour-change principles.
- Programs should be designed with goals in mind and not try to achieve too much at one time.
- The patients who will most benefit should be targeted first. These might include patients with limited literacy, multiple chronic diseases or gaps in care.
- The most effective programs are linked with outpatient care and physician follow up.
- Regular screening and assessment tools may be used to help determine level of service.
- Telephone peer support services may be considered.
- Ongoing assessment of processes for improvement of services are advisable.
Other ways of helping patients beyond consulting rooms and hospitals include:
- Emails
- Real time chats
- Instant messaging
- Video conferencing
RESOURCES
http://joannabriggslibrary.org/jbilibrary/index.php/jbisrir/article/view/284/444
http://www.bmj.com/content/326/7396/966?variant=full-text
http://www.digitalhealth.net/news/22091/polypharmacy-phone-counselling-can-save-lives