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Telephone coaching 'increases costs'

Telephone health coaching in patients with long-term conditions is not linked with any reduction in hospital admissions and increases secondary care costs, show UK researchers.

The study

The analysis included 2,698 patients recruited from local GP practices before 2009 with heart failure, coronary heart disease, diabetes, or COPD; and a history of inpatient or outpatient hospital use. Patients were matched on a 1:1 basis to control patients who received usual care and were from similar areas of England with respect to demographics. Telephone coaching involved a personalised care plan and a monthly phone call. The median length of time enrolled on this service was 25.5 months. As a secondary outcome, secondary care costs were calculated.

The results

After the telephone health coaching enrolment date, emergency admissions were significantly increased by 0.05% admissions per head in the intervention participants compared with the control group. Outpatient attendances increased more quickly in the intervention group, with an increase of 0.16 to 0.58 attendances per head, while secondary care costs increased from £22 to £328 per head.

What this means for GPs

The researchers note that ‘standard telephone health coaching seems unlikely to lead to reductions in hospital use, without the addition of other elements such as telemonitoring, shared decision making for preference sensitive conditions, or predictive modelling’. They also suggest that ‘more care coordination might also be needed’.

BMJ 2013, online 6 Aug

Readers' comments (2)

  • To follow on from the last quote in the article, the researchers add that "Unless health coachers have established relationships with other clinical staff, new interventions could prove to be additions to existing patterns of service use, rather than create efficiencies.”

    To me that reads that they are saying that if you take a new technology-based service, plonk it down into an existing complex health community, without any attempt at integration with existing services or without recognising any new services that might be needed to support it, then it won’t deliver much, if any, benefit. Or put simply: technology is not a simple intervention. How many times do we have to keep proving this and wasting valuable resources in the process, rather than using technology properly to deliver real benefit by integrating it into new care pathways?

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  • The defining difference is always... experienced Clinicians in a decision-making capacity i.e. their informed ability to accept certain levels of uncertainty and explain this to the patient clearly. If the coach is an experienced Clinician of this nature, things could be different but then such people are the very few Clinicians already on the forefront of clinical practice in Primary and Secondary care. So, the more you tell patients about their condition, the more anxious and worked up they will get... thus accessing more help, support and intervention (most.. not all)

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