Clinical predictors of frequent patient telephone calls in Parkinson’s disease

Abstract

Background Patient telephone calls are a major form of unreimbursed healthcare utilization in Parkinson’s disease (PD), yet little is known about potential risk factors for frequent calling behavior. Methods Prospective cohort study of 175 non-demented outpatients with PD. Our primary outcome measure was the frequency of patient telephone calls over a three-month period relative to baseline demographics, State-Trait Anxiety Index (STAI) and Beck Anxiety Inventory (BAI) scores, Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores, and medication use. Based on the median call rate (1 call/3 months), subjects were dichotomized into frequent (≥2 calls) and infrequent (≤1 call) caller groups. Results A total of 297 calls were received, of which 264 (89%) were from the frequent caller group (n = 63 subjects), and only 33 (11%) were from the infrequent caller group (n = 112 subjects). Compared with calls from infrequent callers, those from frequent callers more commonly related to somatic symptoms of PD (46.8% vs. 19.4%, p = 0.007). In multivariate logistic regression analysis, independent predictors of frequent calling were: anxiety (STAI ≥55; adjusted OR = 2.62, p = 0.02), sleep disorders (adjusted OR = 2.36, p = 0.02), dyskinesias (adjusted OR = 3.07, p = 0.03), and dopamine agonist use (adjusted OR = 2.27, p = 0.03). Baseline demographics, UPDRS motor scores, and levodopa use were similar in both groups. Conclusions Frequent patient telephone calls in PD are independently associated with anxiety, sleep disorders, dyskinesias, and dopamine agonist use, with a minority of patients accounting for the majority of calls. Aggressive treatment of these non-motor symptoms and motor complications might potentially reduce the burden of patient telephone calls in PD.

A survey of telephone nurses’ experiences in their encounters with frequent callers

“…The challenge the TNs experienced with FCs in the present study is congruent with the study by Holmström et al (), where FCs constituted a challenge for TNs and often comprised the caller's worries and anxieties. Furthermore, in the background it is described that in several studies the FCs were more likely to have psychiatric comorbidity (Corral et al, ; Edwards et al, ; Fisher et al, ; Liu et al, ; Middleton et al, ; Pirkis et al, ; Ramors‐Rivers et al, ; Spittal et al, ), which also seems to be the case in the present study according to these TNs. It has previously been shown that there is a positive relationship between expressions of concern by the caller and disapproval by the nurse (Ernesäter, Engström, Winblad, Rahmqvist, & Holmström, ).…”

“…Although there is no consensus on a definition of the term, the phenomenon of FCs is described in the studies that use the term. In several studies, the FCs were more likely to have psychiatric comorbidity (Corral, Yaur, Diaz, Simmons, & Sussman, ; Edwards, Bassett, Sinden, & Fothergrill, ; Fisher et al, ; Liu et al, ; Middleton et al, ; Pirkis et al, ; Ramors‐Rivers et al, ; Spittal et al, ). Furthermore, a connection has been found between medical‐psychiatric comorbidity and frequent use of primary care resources (Ferrari, Galeazzi, Mackinnon, & Rigatelli, ).…”

Association Between Telephone Activity and Features of Patients With Inflammatory Bowel Disease

“…An initial analysis of the mean number of telephone encounters per year was calculated to determine the categories of annual telephone encounters for subsequent analysis 1 . Patients were stratified based on the rates of annual telephone encounters: 0-1 phone encounters/year (low telephone encounters (LTE)), 2-5 phone encounters/year, 6-10 phone encounters/year and >10 phone encounters/ year (high telephone encounters (HTE).…”

“…Telephone communication in IBD care is common, and will involve reporting clinical status, treatment, reassurance as well as completion of healthcare forms and insurance authorization. There is limited information on telephone activity volume or the reasons for calls in the care of chronic illness, including IBD 123 . Systematic study of telephone encounters as a predictor of adverse outcomes such as imminent emergency department (ED) use and hospitalization in IBD has not been pursued.…”

Therapies in Parkinsonʼs disease

“…Managing Parkinson's disease patients in an outpatient setting often requires numerous phone calls, most frequently related to symptoms such as anxiety, sleep disorders, dyskinesias and adverse effects due to dopamine-agonist use [57]. Managing Parkinson's disease patients in an outpatient setting often requires numerous phone calls, most frequently related to symptoms such as anxiety, sleep disorders, dyskinesias and adverse effects due to dopamine-agonist use [57].…”