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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