"Phone therapy" changes bad habits.

• Position: Use of telephone to counsel heart attack patients - Special Newsletter Edition: Your Health

By telephoning heart attack survivors at home, nurses significantly can increase the odds that their patients will change unhealthy habits likely to bring them back to the hospital, researchers have found. The technique is part of a new case management system in which nurses counsel heart attack patients during hospitalization and after discharge, phoning them about once a month to check on their progress, answer their questions, and give them positive feedback on their successes. The goal is to help patients lower their risk of another heart attack by quitting smoking, maintaining an exercise program, and lowering cholesterol levels through diet and, if necessary, medication.

At a cost per patient of between $500 and $700 a year, the system reduces heart attack risk for less expense than traditional rehabilitation programs, notes Robert DeBusk, professor of medicine, Stanford University School of Medicine. "This is exactly the kind of program health care reform advocates are looking for. By reducing a patient's risk of subsequent heart attacks, the program reduces the likelihood that the health care system will have to pay for that patient to be hospitalized again. Because it relies on phone contact, the program is relatively inexpensive and it also appears to be much more effective than usual care."

Nurses devoted an average of nine hours of counseling for each patient receiving phone therapy in the year after the heart attack. Those getting counseling were more successful at reducing their heart attack risk factors than patients receiving only usual care. Among the findings:

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