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Good Health’s in the Mail: Mailed Promotions Cut Doctor Visits for Arthritis Patients

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www.ProHealth.com • January 3, 2003


By Becky Ham, Staff Writer
Health Behavior News Service

Handbooks, personalized questionnaires and other mailed health promotion materials improved the overall health of arthritis patients and reduced the frequency of their visits for outpatient treatment, but did not benefit patients with other chronic diseases such as diabetes and high blood pressure, a new study found.

Chronic arthritis sufferers who received health care materials in the mail decreased their outpatient visits by an average of 4.84 visits during a 30-month period, compared with a control group of arthritis patients who did not receive the same materials.

The decrease in visits translated to a net savings of more than $20,000 for study participants who received the mailings, according to lead author Diana L. Dally, Ph.D., of the Kaiser Foundation Health Plan of Ohio, and colleagues. Their findings appear in the November/December issue of the American Journal of Health Promotion.

The study contradicts the "conventional wisdom that these types of intervention programs almost always have a positive effect on chronic disease patients," says project leader and co-author Allan Khoury, Ph.D., M.D., of the Ohio Permanente Medical Group.

The number of outpatient visits by diabetes patients receiving similar mailings did not significantly differ from the number of visits by a diabetes control group. High blood pressure patients who received the mailings actually increased their number of outpatient visits, by an average of 2.89 visits over 30 months, compared with a high blood pressure control group.

The overall health status of the arthritis group receiving the mailings also improved significantly, while overall health for the diabetes and high blood pressure mailing groups did not change, according to the study authors.

Previous studies suggest that some people with chronic diseases, from arthritis to asthma, can learn to manage their condition and improve their health with fewer interventions by professional health care. Health care mailings are a potentially cost-effective way to teach self-management skills to such patients.

But can regular mailings keep individuals out of the clinic or the emergency room? Dally and colleagues tested the effectiveness of a home mailing strategy with 593 members of the Kaiser Permanente of Ohio managed care plan. All members were between 18 and 64 years old and had chronic high blood pressure, diabetes, arthritis or some combination of these conditions that brought them to outpatient care at least 11 times each year over a two-year period.

Half of the patients in the study received regular mailings of personalized questionnaires, individual feedback on their returned questionnaires, health education materials specific to their chronic condition and a health information handbook at regular intervals throughout the study. The other half of participants received only condition-specific health education materials at the end of the study's first year.

Using questionnaires, Dally and colleagues assessed the health status of all participants at the beginning of the study and again at the one-year mark. The arthritis group was the only group to benefit from the mailings.

The mailing strategy appears to generate financial benefits as well: The reduction in outpatient visits for the arthritis group added up to a $20,013 savings over the 30-month study, even after the costs of the mailings were deducted.

The researchers suggest mailings and other similar interventions may have a greater impact on conditions that greatly impair functional health, like arthritis, rather than conditions that cause less severe functional impairment, like high blood pressure.



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