Education by phone affects disease management

Asthma knowledge, diet control increase 19%

A telephone line has proven an effective link between educator and patient in the effort to manage such chronic diseases as asthma, diabetes, and congestive heart failure (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, a service marketed by United Health Care in Dayton, OH, to businesses and other health plans.

For example, there was a 19% increase in knowledge of how to control asthma episodes among patients enrolled through an employer or health care plan. Thirty-three percent of participants measured clinically as having moderate or high-severity asthma moved into the low-severity level as a result of the program. Also, there were 18% more participants with a written action plan from their physician.

Diabetes patients in the commercial population fared just as well. Following the program, 24% more people knew how to change their diabetes management when they had an infection or illness. Preventive care improved, with a 14% increase in people with diabetes receiving an annual eye exam. Ten percent more patients were no longer having any problems at work or in normal social activities.

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. There were 14% more patients experiencing 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. They’re also asked what symptoms they have been experiencing and how frequently. This information helps nurses rank them in categories of severity of illness.

A second section of the profile focuses on the patient’s 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 affecting their ability to function, such as their ability to continue to go to work and school.

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, the two most important areas for asthma patients are learning what triggers their asthma attacks and being on an inhaled anti-inflammatory medication.

Patients often 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 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 the patient has been asked to schedule an appointment to review prescribed medications.

The packet for asthma includes an educational booklet, a log to record peak flow readings, a sample asthma action plan to control asthma flare-ups, and a blank plan they can take to their physician. The CHF packet contains a booklet, a weight chart, an action plan to help them determine when to call their physician, and tips on managing their diet. The diabetes packet has a booklet, a log to report blood sugar levels, information on medications, and tips on managing diet.

During the second phone call, the nurse discusses the information the patients received. The information covered in the first call also 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 currently is no maintenance plan available once the six-month disease management program ends, one is being considered. "We do try to hook patients up with resources in their own community once the program ends," says Smeltzer.

Sources

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: dsmeltze@uhc.com.