Development of an interdisciplinary, telephone-based care program

An interdisciplinary, telephone-based care program at a Veterans Affairs medical center (VAMC) is described. Patients telephoning the Oklahoma City VAMC complained that they were transferred multiple times and that they had difficulty contacting their provider between scheduled visits. Some went to the walk-in urgent care clinic with nonurgent problems. The average waiting time in the clinic exceeded three hours. An interdisciplinary, telephone-based care program was begun in 1995 to allow efficient problem resolution over the telephone; provide clinical consultations, interventions, and referrals as necessary; and reduce use of the urgent care clinic for nonurgent problems. A team consisting of a patient service representative, a pharmacist, and a nurse was established to handle calls. Policies and procedures were designed to respond appropriately to patients' problems and document the telephone "visits." The pharmacist was given practice privileges, including prescribing authority. A questionnaire indicated patient satisfaction with the new service. Mean waiting times in the urgent care clinic were reduced to less than two hours, and an estimated annual net cost avoidance of $677,671 was achieved by the program's averting unnecessary visits to the urgent care clinic. An interdisciplinary, telephone-based care program at a VAMC successfully responded to patients' concerns, improved their access to care, and conserved urgent care resources.