Original article
Alimentary tract
Association Between Telephone Activity and Features of Patients With Inflammatory Bowel Disease

https://doi.org/10.1016/j.cgh.2013.11.015Get rights and content

Background & Aims

Telephone communication is common between healthcare providers and patients with inflammatory bowel disease (IBD). We analyzed telephone activity at an IBD care center to identify disease and patient characteristics associated with high levels of telephone activity and determine if call volume could identify individuals at risk for future visits to the emergency department (ED) or hospitalization.

Methods

We performed a prospective observational study in which we categorized telephone calls received by nursing staff over 2 years at a tertiary care IBD clinic (2475 patients in 2009 and 3118 in 2010). We analyzed data on 21,979 ingoing and outgoing calls in 2009 and 32,667 calls in 2010 and assessed associations between clinical factors and logged telephone encounters, and between patterns of telephone encounters and future visits to the ED or hospitalization.

Results

Telephone encounters occurred twice as frequently as office visits; 15% of the patients generated >10 telephone encounters per year and were responsible for half of all telephone encounters. A higher percentage of these high telephone encounter (HTE) patients were female, had Crohn's disease, received steroid treatment, had increased levels of C-reactive protein and rates of erythrocyte sedimentation, had psychiatric comorbidities, and had chronic abdominal pain than patients with lower telephone encounters. The HTE patients were also more frequently seen in the ED or hospitalized over the same time period and in subsequent years. Forty-two percent of patients with >8 telephone encounters within 30 days were seen in the ED or hospitalized within the subsequent 12 months.

Conclusions

Based on an analysis of telephone records at an IBD clinic, 15% of patients account for half of all calls. These HTE patients are a heterogeneous group with refractory disease who are likely to visit the ED or be hospitalized.

Section snippets

Methods

The study was performed in a tertiary referral IBD clinic where patients contacted the center via telephone regarding questions or concerns involving their care and health status. Nursing personnel handled all routine telephone calls involving the clinic population. There is approximately a 1:1 ratio of nursing support for each physician.

Telephone activity was quantified in two cohorts. In the first, all telephone calls received and performed by nursing staff were prospectively tabulated over a

Results

The IBD center cared for 2475 patients in 2009 and 3118 in 2010, which corresponded with 21,979 ingoing and outgoing calls in 2009 and 32,667 calls in 2010. No specific month demonstrated peak telephone activity during the 2-year study period (Figure 1A).

The telephone activity pattern remained stable over the 2-year period: 52% patient-generated calls regarding a problem or follow-up, 25% nurse-generated calls with a resolution or plan, 12% refill requests, 10% insurance authorizations, and 1%

Discussion

Telephone communication is essential in modern society as an estimated 85% of American adults use cell phones regularly,10 but there is limited information regarding the scope and characteristics of telephone activity in the care of a specific chronic illness. In this analysis of telephone activity in the care of patients with IBD, we identified the following: (1) the total number of telephone calls in the overall care of a patient with IBD averages 8–10 per year; (2) more than 10% of annual

Acknowledgments

The authors acknowledge the UPMC IBD Center nursing staff that assisted with documentation of telephone activity that formed the basis for this project: Beth Rothert, RN, Linda Kontur, RN, Diane Sabilla, RN, Ashley Holtzman, RN, Jennifer Rosenberry, RN, and Kristy Rosenberry, RN. David G. Binion had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Conflicts of interest The authors disclose no conflicts.

Funding Eric J. Vargas was supported by a Doris Duke Charitable Research Foundation, National Institute of Mental Health R25 Fellowship award. Michael Dunn and David G. Binion were supported by a Grant W81XWH-11-2-0133 from the US Army Medical Research and Materiel Command.

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