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Use of telephone care in a cardiovascular disease management programme for type 2 diabetes patients in Santiago, Chile

VA Ann Arbor Healthcare System and University of Michigan Diabetes Research and Training Center, PO Box 130170, Ann Arbor, MI 48113-0170, USA, jpiette{at}umich.edu

Ilta Lange

Escuela de Enfermería, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul 6904411, Santiago, Chile

Michelle Issel

University of Illinois-Chicago, School of Public Health, 1603 West Taylor Street (MC 923), Chicago, IL 60612, USA

Solange Campos

Escuela de Enfermería, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul 6904411, Santiago, Chile

Claudia Bustamante

Escuela de Enfermería, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Macul 6904411, Santiago, Chile

Jaime Sapag

Departamento Medicina Familiar, Escuela de Medicina, Pontificia Universidad Católica de Chile, Lira 44, Santiago Centro 830023, Santiago, Chile

Fernando Poblete

Departamento Medicina Familiar, Escuela de Medicina, Pontificia Universidad Católica de Chile, Lira 44, Santiago Centro 830023, Santiago, Chile

Peter Tugwell

Institute of Population Health, University of Ottawa, One Stewart Street, Ottawa, Ontario K1N 6N5, Canada

Annette M. O'Connor

Institute of Population Health, University of Ottawa, One Stewart Street, Ottawa, Ontario K1N 6N5, Canada

Objectives: In 2004, the Chilean National Ministry of Health instituted a cardiovascular disease (CVD) management programme aimed at improving diabetes care among patients treated in the public healthcare system. We sought to identify the characteristics of patients participating in the CVD programme and the feasibility of extending its reach through structured nurse telephone contacts between outpatient encounters.

Methods: We surveyed 569 low-income adults with type 2 diabetes treated in public clinics of Santiago, to assess patients' participation in the CVD programme and willingness to use telephone care services. Surveys were linked to information from medical records.

Results: One-third of patients met the target of two visits to the CVD programme in the previous 6 months, and an additional 32% made more than three visits. Use of the CVD programme was associated with greater patient satisfaction, even after controlling for potential confounders. However, 27% of patients had inadequate programme contact, and many of these patients were in poor health. Many CVD programme participants reported difficulties with lifestyle changes, and greater contact with the CVD programme was not associated with healthier behaviours. Most patients (95%) reported telephone access and 37% had used the telephone to contact their clinic. The majority of patients would be willing to use telephone care for additional behaviour change and emotional support. Patients with fewer CVD programme visits were particularly likely to report willingness to use telephone care.

Discussion: Clinic-based CVD disease management services reach a large number of socio-economically vulnerable Chileans with diabetes. However, barriers to access remain, and planned telephone care services may increase the reach of self-management support.

Key Words: Telephone care • Care management • Access to care • Diabetes

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