Abstracts

Patient telephone calls are a considerable aspect of epilepsy outpatient clinical care often delivered by registered nurses classified as coordinators. This portion of patient care carries with it a significant unreimbursed cost that is not accounted for by insurers or health care providers and there is not a charge to patients for this service. Therefore, we investigated the amount of time that is spent on telephone care for epilepsy patients and estimated the cost of providing this care.
All phone calls during regular business hours taken by an epilepsy coordinator, who is solely responsible for all patient phone calls for a 2 neurologist epilepsy team, were prospectively recorded for a two week period to include: length of time on phone, and the purpose and outcome of the call. Analyzed calls included ones from patients, family members, outside pharmacies, and medical facilities from outside the institution. All calls pertained to individuals with epilepsy. Any phone calls regarding individuals without epilepsy were excluded from the analysis. We then calculated the cost of various health professionals delivering this telephone care by using US average salary per hour (excluding benefits) figures for neurologists, physician assistants, nurse practitioners and staff nurses.
In an 80-hour work period, there were over 80 phone calls documented for a total of 28 hours (14 hours/ week) or an average of 2.8 hours/work day or 728 hours/ year spent on telephone care. This accounts for over 25% of the work period. The greatest amount of time spent was for medication refills at 4.4 hrs/ week and the second was for counseling or education issues at 3.7 hours/ week. The purpose of other phone calls included: reporting a seizure that required attention; 2.2 hours/week, medication questions and side effects; 2.0 hours/ week, requests for disability letters or forms; 1 hours/ week, and appointments; 0.7 hours/week. The unreimbursed costs of delivering this care by a staff nurse per year is $13,286, by a nurse practitioner $21,912, by a physician assistant $24,832 and by a neurologist is $ 54,345.
Telephone care accounts for a large portion of epilepsy treatment. There is a significant unreimbursed cost for telephone care, which is not addressed by insurers, and is not a cost for patients. Further studies are needed looking at other centers, and assessing the best manner to deliver cost efficient telephone care incorporating the needs of the patient, health professionals and society in general.