Monday, 31 August 2015

SPHPM researchers look at the effectiveness of telephone support services

SPHPM’s Renata Morello, Associate Professor Anna Barker, Professor Andrew Forbes, Professor Just Stoelwinder, with researchers from Deakin University and the University of Melbourne, have published an article in the journal Population Health Management assessing the effectiveness of a telephone health coaching and support program delivered to members of a private health insurance fund. 

In an effort to better improve the management of patient care within the community, health care organisations are introducing new strategies to minimise the number of avoidable hospitalisations. One intervention that has been widely used for people with a chronic disease is one-to-one telephone support and coaching.

The program administers support to individuals, advocating for better health behaviours and incorporate various components, such as goal setting, motivational interviewing and coordination of care across multiple health services. The use of telephone coaching means personalised care to a large region at a cost-effective price. While these programs have seen positive results in a cohort of chronic illness sufferers, there is limited evidence on its impact on a wider population group who have a various number of conditions or complex needs.

This study examined the effectiveness of an existing telephone support program.  The program was administered to the elderly members of a private Australian health insurance fund who had either complex care requirements or a chronic illness. It encouraged members to remain at home, and improve access to community-focused services as well as help them with self-management of their illness. This was to minimise the chance of unnecessary hospital admissions. The program had not been evaluated prior to this study. The 273 members from the insurance fund who had been a part of the program were matched to members who hadn’t enrolled in the program or any other illness management program offered by the private health insurance fund. Eligibility criteria included: community dwelling; over the age of 65; and two or more hospital admissions in the past 12 months before they had enrolled in the program. The authors utilised a case-control pre-post study design through the use of propensity score matching.

All members in  the program received one-on-one telephone support, a personalised care plan and referrals to community based health services. The members in the control group had access to their existing health services. The primary outcomes included both the number of hospital admission claims and the total benefits paid for all the health care utilisations in the 12 month period post program enrolment. The secondary outcomes also included the change in benefits paid, hospital and ancillary benefits paid and the total number of hospital bed days over the 12 months post program enrolment.
When compared against the controls, the results indicated that the program did not seem to minimise the health care usage or benefits paid over the 12 months post program enrolment. Furthermore, there were no reductions in the quantity of overnight hospital admission or the number of hospital bed day stays. The broad focus of this program or challenges faced with its implementation may have influenced its effectiveness.

The authors conclude that the program did not lead to any reductions in the use of the health care services or any related costs. There is still a lack of evidence to support the effectiveness of phone support or coaching to minimise hospital usage in participants who suffer from a broad range of chronic conditions or have complex care needs. A review of the target population, program procedures and measurement tools would be useful if the program is to be continued.

You can read the paper here.

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