Phone education impacts disease management

CHF knowledge increases, diet control up 19%

A telephone line has proven an effective link between educator and patient to manage chronic diseases such as CHF.

Patients enrolled in the Optum Disease Management Program never see the nurse in person, but the education that takes place by telephone over a six-month period has had an impact, says Diane Smeltzer, RN, MHA, director of operations for Optum disease management program, a service marketed by United Health in Ohio.

No magic here, just proven methods

As a result of the education, 18% more people in the CHF Medicare category took the appropriate actions when they were experiencing symptoms. Following instruction on a low-sodium diet, 19% of CHF patients made healthy improvements in their diet. An increase of 14% experienced no problems with work or normal social activities.

There was no magic formula used in the disease management efforts, just a simple, methodical education approach. During the first telephone call the nurse goes through a patient profile that addresses several issues. Patients are asked how many times they visited the emergency department in the last six months and if they have been hospitalized as a result of their disease. Alsothe nurse asks what symptoms they have been experiencing and how frequently. This information helps nurses to rank patients in categories of severity of illness.

A second section of the profile focuses on the patient’s knowledge and ability to manage health. "We want to find out about their disease and what they know about how they should be taking care of themselves. This is a key area for us because this is how we gear our education," says Smeltzer. The profile also covers how the disease is impacting their ability to function, such as their ability to continue to go to work and school.

Education priorities identified

During the first phone call, the educational needs of the patient are prioritized based on national guidelines and the nurse tries to help the patient set some goals. For example, two important areas for CHF patients are learning weight control and compliance with medication guidelines.

Often patients will be asked to work toward identifying their triggers and to schedule an appointment with their physician to get on the appropriate medication.

After the first phone call, patients are sent a letter and a packet of information on their chronic disease. They are told that a nurse will call in a couple of weeks after they have had time to read over the information. A letter also is sent to each patient’s physician stating that their patient has been asked to schedule an appointment to review prescribed medications.

The CHF packet contains a booklet, a weight chart, an action plan to help patients determine when to call their physician, and tips on managing diet.

During the second phone call the nurse discusses the information the patients received. Also the information covered in the first call is discussed to determine if they are working on their goals. "Once the initial call has taken place, every subsequent call is a check on their progress. We determine, based on their progress, whether we’re ready to move on to the next item of education or if we have to stay at the same point," says Smeltzer.

The final two calls are made at three-month and six-month intervals. The same patient profile taken during the first telephone call is covered once again in the final session to measure outcomes. In between formal phone calls initiated by the nurse, patients can call a toll-free number if they have any questions, problems, or needs.

Although there is currently no maintenance plan available once the six-month disease management program ends, one is being considered. "We do try to hook up patients with resources in their own community once the program ends," says Smeltzer.

For more information on the Optum Disease Management Program, contact: Diane Smeltzer, RN, MHA, Director of Operations, Optum Disease Management Program, 369 West First St., Suite 235, Dayton, OH 45402. Telephone: (937) 220-9114, ext. 7910. Fax: (937) 220-9152. E-mail: