Use telephone education for disease management
Use telephone education for disease management
Asthma knowledge jumps 19%
A telephone line has proved an effective link between educator and patient to manage such chronic diseases as asthma, diabetes, and congestive heart failure.
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 the Optum disease management program, 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.
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, if they have been hospitalized for asthma, what symptoms they have been experiencing, and how frequently. This information helps nurses to rank them 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.
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 up 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.
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 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 his or her physician.
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. 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 patients up with resources in their own community once the program ends," says Smeltzer.
[Editor’s note: 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: [email protected].]
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