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Editor's Correspondence
October 14, 2002

Practical Utility of Case-Management Telephone Intervention in Heart Failure?—Reply

Arch Intern Med. 2002;162(18):2142. doi:

In reply

We appreciate careful assessments of our research such as that provided by Dr Peterson; however, our study, as well as several others, confirms the practical utility of telephonic case management1 and other types of disease management for patients with heart failure.2-4 His confusion regarding the nature of the intervention suggests that he missed the graphic depiction of the interventions of the nurse case managers in the article. Specifically, nurses monitored, educated, and counseled patients by telephone in a standardized fashion guided by a computer program designed by clinical experts to support national guidelines. During the calls, the nurses educated patients regarding such topics as medication adherence, diet recommendations, and identification of worsening signs and symptoms with the goal of improving intermediary factors that would influence important outcomes such as hospitalization. Physicians were notified of discrepancies between patients' reports of medications and treatments vs actual physician orders. Because of the dynamic nature of individual case management of patients with heart failure, further understanding of the standardized intervention would be facilitated best by perusal of the software available from Pfizer, Inc (http://www.AHWHF@pfizer.com). In reference to the point that intermediary factors responsible for improved outcomes are unknown, we agree, as noted in the "Comment" section. Clear understanding of the specific factors responsible for improved outcomes will require further study, as is the case whenever a packaged intervention is studied. However, whatever the mechanism, the intervention was obviously effective and may be of benefit to health care organizations struggling with persistently high heart failure readmission rates.

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