Design. —Randomized trial. Setting. —A primary care clinic. Patients. —Four hundred ninety-seven men aged 54 years or older. Objective. —We examined the hypothesis that substituting clinician-initiated telephone calls (telephone care) for some clinic visits would reduce medical care utilization without adversely affecting patient health. Intervention. —Clinicians were asked to double their recommended interval for face-to-face follow-up and schedule three intervening telephone contacts; for control patients, the follow-up interval recommended by their clinician was unchanged. Main Outcome Measures. —Use of medical services and health status. Results. —During the 2-year follow-up period, 7% of patients withdrew or became unavailable. Telephone-care patients had fewer total clinic visits, scheduled and unscheduled, than usual-care patients (19%, P P =.006), fewer admissions, and shorter stays in the hospital (28% fewer total hospital days, P =.005), and 41% fewer intensive care unit days ( P =.03). Estimated total expenditures for telephone care were 28% less per patient for the 2 years ($1656, P =.004). For the subgroup of patients with fair or poor overall health at the beginning of the study (n= 180), savings were somewhat greater ($1976, P =.01). In this subgroup, improvement in physical function from baseline ( P =.02) and a possible reduction in mortality ( P =.06) were also observed. Conclusion. —We conclude that substituting telephone care for selected clinic visits significantly reduces utilization of medical services. For more severely ill patients, the increased contact made possible by telephone care may also improve health status and reduce mortality. ( JAMA . 1992;267:1788-1793)

Telephone care as a substitute for routine clinic follow-up.

The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.

Compliance with cardiovascular disease prevention strategies: A review of the research

DEFINED BROADLY, TELEMEDICINE is the use of electronic information and communications technologies to provide and support health care when distance separates the participants. The term is also applied more narrowly to medical applications that use interactive video, typically for specialty or subspecialty physician consultations. Sometimes the term telehealth is used to encompass educational, research, and administrative uses as well as clinical applications that involve nurses, psychologists, administrators, and other nonphysicians. Telemedicine using interactive video made its debut about 40 years ago to support neurologic and psychiatric services in Nebraska. Through the early 1990s, telemedicine mostly involved specialty consultations via videoconference technology. Recently, more attention has focused on noninteractive applications, including those that use relatively inexpensive store-andforward technologies to save and then transmit text and images (essentially, multimedia e-mail). Both interactive and noninteractive technologies are increasinglyusedorpromoted for remote monitoring of health status in homes and other settings. Given the range of applications and technologies, evaluating the effectiveness of telemedicine means individually evaluating different combinations of technologies and clinical or other uses.

https://jamanetwork.com/journals/jama/articlepdf/195133/JCT20001.pdf

Telemedicine and remote patient monitoring.

A recently burgeoning body of research suggests that social ties increase people's immunity to physical illnesses. Study findings form a conceptual foundation for an emerging social support system theory that includes social network structure, social support content, and behaviors and social conditions involved in mobilizing support. As a result, knowledge about person-environment fit and health status is advanced. Social work has a special opportunity to refine further social support system theory and intervention.

Social Networks, Social Support, and Health Status: A Review

Team-based care is one of the key components of the patient-centered medical home. Studies have consistently demonstrated that teams involving pharmacists or nurses in patient management can significantly improve blood pressure control. These findings have been demonstrated in several meta-analyses and systematic reviews. These reviews have generally found that team-based care can reduce systolic blood pressure by 4-10 mm Hg over usual care. However, these reviews have also concluded that many of the studies had various limitations and that additional research should be conducted. The present state of the art review paper will highlight newer studies, many of which were funded by the National Institutes of Health. Newer strategies involve telephone and/or web-based management which is an evolving area to improve blood pressure control in large populations. Social media and other technology is currently being investigated to assist pharmacists or nurses in communicating with patients to improve hypertension management. Few cost-effectiveness analyses have been performed but generally have found favorable costs for team-based care when considering the potential to reduce morbidity and mortality. The authors will suggest additional research that needs to be conducted to help evaluate strategies to best implement team-based care to improve blood pressure management.

/pdf/the-hypertension-team-the-role-of-the-pharmacist-nurse-and-40lbq5ficb.pdf

The hypertension team: the role of the pharmacist, nurse, and teamwork in hypertension therapy.

The cost-effectiveness of counseling by telephone and by clinic visit contacts were compared in 40 hypertensive patients each of whom received counseling and reinforcement every three weeks for six months regarding diet, exercise, smoking, and coping with stress Blood pressure declined significantly in both counseling groups (N: 10 each) but not in a control group (N: 20) The cost per patient under control was $82 for the clinic counseling and $39 for the telephone counseling strategy, suggesting that telephone counseling was a cost-effective technique

E M Bertera

Papers

The cost-effectiveness of telephone vs clinic counseling for hypertensive patients: a pilot study.