Telephone care as an adjunct to routine medical follow-up. A negative randomized trial

Abstract

Context: In 1992, a randomized trial at one outpatient clinic demonstrated that making telephone appointments part of routine medical follow-up could save money and reduce hospitalization.

Objective: To ascertain the effects of telephone care in other clinics.

Design: Consenting patients of 20 physicians were randomly assigned to receive telephone care or usual care.

Setting: Veterans Affairs General Medical Clinics in Denver, Colorado, and Sioux Falls, South Dakota.

Patients: 512 predominately male elderly veterans (mean age, 68 years) who had a broad range of chronic medical conditions.

Intervention: At the intake clinic visit, the recommended revisit interval (e.g., return in 3 months) for telephone care patients was doubled (e.g., return in 6 months) and three intervening telephone appointments were scheduled. Three telephone appointments were also scheduled at all subsequent clinic visits.

Main outcome measures: Utilization of services and self-reported health status.

Results: More than 2000 calls were made during the 2-year study period. Although the revisit interval was longer for telephone care patients after the intake visit (as was expected), it was the same for both telephone care and usual care patients after all subsequent visits, despite the scheduling of three telephone appointments for telephone care patients. The intervention had no effect on self-reported health status, hospital admission, or number of deaths. The intervention also had no effect on the total number of clinic visits, outpatient laboratory tests, or radiologic tests. Telephone care patients had fewer unscheduled visits than did usual care patients (2.0 vs. 2.8 visits/patient; P = 0.01).

Conclusion: Telephone care had little effect in this study. Instead of providing a way to maintain contact with patients without requiring them to appear in clinic frequently, telephone appointments became simply an additional service.