We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

Telephone Care as a Substitute for Routine Clinic Follow-up

John Wasson, MD; Catherine Gaudette; Fredrick Whaley, PhD; Arthur Sauvigne, MD; Priscilla Baribeau; H. Gilbert Welch, MD, MPH
JAMA. 1992;267(13):1788-1793. doi:10.1001/jama.1992.03480130104033.
Text Size: A A A
Published online

Design.  —Randomized trial.

Setting.  —A primary care clinic.

Patients.  —Four hundred ninety-seven men aged 54 years or older.

Objective.  —We examined the hypothesis that substituting clinician-initiated telephone calls (telephone care) for some clinic visits would reduce medical care utilization without adversely affecting patient health.

Intervention.  —Clinicians were asked to double their recommended interval for face-to-face follow-up and schedule three intervening telephone contacts; for control patients, the follow-up interval recommended by their clinician was unchanged.

Main Outcome Measures.  —Use of medical services and health status.

Results.  —During the 2-year follow-up period, 7% of patients withdrew or became unavailable. Telephone-care patients had fewer total clinic visits, scheduled and unscheduled, than usual-care patients (19%, P<.001). In addition, telephone-care patients had less medication use (14%, P =.006), fewer admissions, and shorter stays in the hospital (28% fewer total hospital days, P =.005), and 41% fewer intensive care unit days (P=.03). Estimated total expenditures for telephone care were 28% less per patient for the 2 years ($1656, P =.004). For the subgroup of patients with fair or poor overall health at the beginning of the study (n= 180), savings were somewhat greater ($1976, P=.01). In this subgroup, improvement in physical function from baseline (P=.02) and a possible reduction in mortality (P=.06) were also observed.

Conclusion.  —We conclude that substituting telephone care for selected clinic visits significantly reduces utilization of medical services. For more severely ill patients, the increased contact made possible by telephone care may also improve health status and reduce mortality.(JAMA. 1992;267:1788-1793)


Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.