Physician-patient communication and patient satisfaction in Japanese cancer consultations

Over the past few decades, physician-patient communication has been intensively studied in western countries, because of its importance for the physician-patient relationship and patient health outcomes. Although various concepts and models of this relationship have recently been introduced in Japan, there are few studies on Japanese physician-patient interaction. The purpose of this study is to describe characteristics of physician-patient communication in a Japanese cancer consultation, and to examine the relation of this interaction with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. The Roter Interaction Analysis System (RIAS), one of the most frequently used systems for analyzing physician-patient interaction, was applied, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. It can be concluded that the structure of the physician-patient interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between physician-patient communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation.     

Complicating the Diagnosis: A Response to Lammers and Duggan

Despite its potential, the use of e-mail for physician-patient communication has not been widely adopted. Our purpose was to survey the experiences of physicians who are early adopters of the technology. Physicians, identified through a professional Internet information portal, completed a survey, including an assessment of satisfaction with using e-mail with patients. We identified 204 physicians who reported using e-mail with patients on a daily basis. Average age of the respondents was 49 years, 82% were male, and 35% were primary-care physicians. Among the 204 frequent users, commonly reported e-mail topics were new, nonurgent symptoms, and questions about lab results. Despite their daily use, 25% were not satisfied with physician -patient e-mail. The most important reasons for using e-mail with patients among those who were satisfied were "time saving" (33%) and "helps deliver better care" (28%) compared with "patient requested" (80%) among those who were not satisfied (p <. 01). Dissatisfied physicians reported concerns about time demands, medicolegal risks, and ability of patients to use e-mail appropriately. Although the majority of these "vanguard" physicians reported benefits, some did not recommend that colleagues adopt this new technology. Increasing integration into practice to enhance time-saving aspects and improve patient education might lead to more sustained use of this promising communication tool.     

Continuity of care and the physician-patient relationship: the importance of continuity for adult patients with asthma

BACKGROUND: We assessed the role and importance of continuity of care in predicting the perceptions of the physician-patient relationship held by patients with asthma. METHODS: We analyzed the 1997 statewide probability survey of adult Kentucky Medicaid recipients. The participants included 1726 respondents with 2 or more visits to a physician's office, clinic, or emergency department in the previous 12 months. Of these, 404 reported having asthma. The respondents used 5-point single-item scales to rate continuity of care, provider communication, and patient influence over treatment. RESULTS: Multivariate linear regression analyses were used to assess the contribution of continuity of care to provider communication and patient influence in the presence of control variables. Those variables included age, sex, education, race, number of visits, general health, health improvement, and life satisfaction. For persons with asthma, continuity of care was the only variable that significantly contributed to the provider communication model (P = .01) and the only variable other than life satisfaction that contributed to the patient influence model (P < .05 for each). For patients who did not have asthma, continuity of care was one of several variables contributing significantly (P < .05) to the provider communication and patient influence models. CONCLUSIONS: Particularly for patients with asthma, continuity of care was linked to patient evaluations of their interaction with the physician. Because of this, changes in health care systems that promote discontinuity with individual physicians may be particularly disruptive for patients with chronic diseases.     

Experiences of physicians who frequently use e-mail with patients

Despite its potential, the use of e-mail for physician-patient communication has not been widely adopted. Our purpose was to survey the experiences of physicians who are early adopters of the technology. Physicians, identified through a professional Internet information portal, completed a survey, including an assessment of satisfaction with using e-mail with patients. We identified 204 physicians who reported using e-mail with patients on a daily basis. Average age of the respondents was 49 years, 82% were male, and 35% were primary-care physicians. Among the 204 frequent users, commonly reported e-mail topics were new, nonurgent symptoms, and questions about lab results. Despite their daily use, 25% were not satisfied with physician-patient e-mail. The most important reasons for using e-mail with patients among those who were satisfied were "time saving" (33%) and "helps deliver better care" (28%) compared with "patient requested" (80%) among those who were not satisfied (p <.01). Dissatisfied physicians reported concerns about time demands, medicolegal risks, and ability of patients to use e-mail appropriately. Although the majority of these "vanguard" physicians reported benefits, some did not recommend that colleagues adopt this new technology. Increasing integration into practice to enhance time-saving aspects and improve patient education might lead to more sustained use of this promising communication tool.     

Physician assessment of patient motivation: influence on disposition for follow-up care.

This study of 3,318 outpatient visits evaluated the influence of the physician-assessed level of patient motivation on the level of physician involvement in follow-up care. Data collected included patient demographics, health risk factors, physician-assessed level of patient motivation, and the disposition for follow-up care (return office visit or self-care). Physicians more frequently scheduled patients for a return office visit, regardless of assessed level of patient motivation, when they presented with a traditional biomedical problem. Patients with health promotion-disease prevention problems were more frequently relegated to self-care; patients physicians judged to be poorly motivated were four times as likely to be relegated to self-care. We discuss the implications of physician overuse of self-care strategies on the health status of poorly motivated patients. Factors influencing such physician behavior may include prior unrewarding experiences with poorly motivated patients, perceived lack of skill in affecting behavior change, time constraints, lack of reimbursement for preventive care services, and the actual process of physician education and professional socialization.     

An office-based Internet patient education system: a pilot study

BACKGROUND: Patients' use of the Internet to find medical information is increasing, and physicians are exploring ways to incorporate the Internet into patient education programs and physician-patient encounters. We performed a pilot study of an Internet patient education system to obtain information on the usefulness of, feasibility of, and patient satisfaction with this type of information. METHODS: We developed a hypertext Web page directory to patient education sites on the Internet and made it available to patients in a community-based family practice residency clinic during their office visit. During a 1-month period, a medical student assisted patients with using the Internet, answered questions, interviewed patients, and collected data. Information was collected on sites visited, level of assistance required, amount of time spent "surfing" on-line versus intense reading on-line, quality of the experience, perceived usefulness of the educational materials, and patients' satisfaction with the materials. RESULTS: Fifty patients participated in the study. Forty-seven patients (94%) found the Internet information helpful. Most patients spent their time on-line intensely reading, and men spent significantly more time on-line (P = .007). Thirty-seven patients (77%) stated they would change a health behavior because of information they had read on the Internet; 45 (90%) were more satisfied with their visit than usual, and 46 (92%) would use the Internet center at the clinic again. CONCLUSIONS: Patients can obtain useful information from moderated Internet patient education systems and may plan to change health behaviors on the basis of that information. Internet patient information in the physician's office can improve patient satisfaction with clinic visits.     

Ambulatory care visits and physician satisfaction: from medical directors' perspectives

BACKGROUND: Under the universal health insurance system in Taiwan, policy makers seek new approaches to balance rising costs and quality of care. One policy, Ambulatory Care Reimbursement, enacted in 2001 has effectively reduced patient numbers in clinics by cutting per patient reimbursement when a physician has seen over predetermined number of patients. PURPOSE: To access the impact of this policy on physician satisfaction in regional hospitals and medical centers (MCs) from the point of view of their medical directors. METHODOLOGY: We conducted a cross-sectional survey of medical directors from 25 MCs and 78 regional hospitals in Taiwan. The survey used a 5-point Likert scale to identify both impacts of reduced ambulatory care visits and physician satisfaction. We randomly selected 30% of all medical directors from both types of medical institutions. Of the 248 medical directors contacted, 142 replied. Excluding 5 incomplete responses, our final sample was 137. Response rates were roughly equivalent for MCs (54.67%) and regional hospitals (57.89%). FINDINGS: Medical directors were typically male, aged 45.11 years, worked in MCs (60%), and were general practitioners (43.1%). Multiple regressions associated three independent predictors of physician satisfaction: physician-patient interaction (beta = .393, p = .001), mission (beta = .351, p = .007), and reduced health care expenditures (beta = .179, p = .014). Medical directors more often characterized the regulation of reducing number of visits as a means of encouraging MCs and regional hospitals to improve physician interaction with patients and, thus, associated it with greater patient satisfaction. Generally, directors did not believe that the regulation encouraged patients seeking care at other hospitals or that it resulted in reduced pay to physicians. PRACTICE IMPLICATION: Reducing ambulatory care visits has promoted the physician-patient relationship and allowed many physicians attain their medical mission. Such regulation had influence on the physicians' satisfaction.     

Annals Journal Club: Physician Satisfaction with Chronic Care Processes: A Cluster-Randomized Trial of Guided Care

PURPOSE Chronically ill older patients with multiple conditions are challenging to care for, and new models of care for this population are needed. This study evaluates the effect of the Guided Care model on primary care physicians’ impressions of processes of care for chronically ill older patients.METHODS In Guided Care a specially educated registered nurse works at the practice with 2 to 5 primary care physicians, performing 8 clinical activities for 50 to 60 chronically ill older patients. The care model was tested in a cluster-randomized controlled trial between 2006 and 2009. All eligible primary care physicians in 14 pods (teams of physicians and their chronically ill older patients) agreed to participate (n = 49). Pods were randomly assigned to provide either Guided Care or usual care. Physicians were surveyed at baseline and 1 year later. We assessed the effects of Guided Care using responses from 38 physicians who completed both survey questionnaires. We measured physicians’ satisfaction with chronic care processes, time spent on chronic care, knowledge of their chronically ill older patients, and care coordination provided by physicians and office staff.RESULTS Compared with the physicians in the control group, those in the Guided Care group rated their satisfaction with patient/family communication and their knowledge of the clinical characteristics of their chronically ill older patients significantly higher (ρ<0.05 in linear regression models). Other differences did not reach statistical significance.CONCLUSIONS Based on physician report, Guided Care provides important benefits to physicians by improving communication with chronically ill older patients and their families and in physicians’ knowledge of their patients’ clinical conditions.     

Relationships between physician practice style,patient satisfaction,and attributes of primary care

OBJECTIVES: Style of physician-patient interaction has been shown to have an impact on patient outcomes. Although many different interaction styles have been proposed, few have been empirically tested. This study was conducted to empirically derive physician interaction styles and to explore the association of style with patient reports of specific attributes of primary care, satisfaction with care received, and duration of the visit. STUDY DESIGN: A cross-sectional observational study. POPULATION: We observed 2881 patients visiting 138 family physicians for outpatient care in 84 community family practice offices in northeast Ohio. OUTCOMES MEASURED: Components of Primary Care Instrument (CPCI), patient satisfaction, and duration of the visit. RESULTS: A cluster analysis of variables derived from qualitative field notes identified 4 physician interaction styles: person focused, biopsychosocial, biomedical, and high physician control. Physicians with the person-focused style rated highest on 4 of 5 measures of the quality of the physician-patient relationship and patient satisfaction. In contrast, physicians with the high-control style were lowest or next to lowest on the outcomes. Physicians with a person-focused style granted the longest visits, while high-control physicians held the shortest visits-a difference of 2 minutes per visit on average. The associations were not explained away by patient and physician age and gender. CONCLUSIONS: In community-based practices, we found that the person-focused interaction style appears to be the most congruent with patient reported quality of primary care. Further investigation is needed to identify ways to support and encourage person-focused approaches and the time needed to provide such care.     

How physician communication influences recognition of depression in primary care

BACKGROUND: The relationship between physician communication patterns and the successful recognition of depression is poorly understood. METHODS: We used unannounced visits by actors playing standardized patients to evaluate verbal communication between primary care physicians and a patient presenting with a minor depression scenario. Participants (n = 77) were assigned to receive 2 visits from a man or woman portraying a 26-year-old patient with chronic headaches who meets the criteria for minor depression. The standardized patients carried hidden audiotape recorders and high-fidelity microphones to document the encounters. The audiotapes were coded at 2-second intervals. These data were linked to information gathered from standardized patient checklists, medical records, and debriefing telephone calls with participants. RESULTS: We obtained complete data on 59 (77%) of the physician-patient encounters; of those, 43 (73%) of the physicians recognized depression. Physicians who recognized depression asked twice as many questions about feelings and affect compared with those who did not (for feelings: 1.9% of total physician activity vs. 0.9%, P = .017; for affect: composite score of 2.7% of total physician activity vs 1.3%, P = .003). We found no differences in the proportion or timing of broad to narrow questioning between those who did and did not recognize depression. Physicians who successfully recognized depression later in the interview showed an increase in questions about feelings in the quartile just before recognition occurred. CONCLUSIONS: Physicians who recognized depression differed significantly in the percentage of questions about feeling and affect, and an increase in questions about feelings may precede a diagnosis of depression, though more research is needed to establish this as an important finding.     

Patients' perceptions of physicians communication and outcomes of the accrual to trial process

The purpose of this study was to examine the relations among patients' perceptions of their physicians' communicative behavior during the informed consent interview, the patient's feeling of being confirmed by the physician and satisfied with care delivered by the physician, and the patient's decision to participate in a clinical trial or not. Respondents included 130 cancer patients who were eligible for a clinical trial and who had recently discussed trial participation with their physicians. Results indicated that a linear combination of the variables physician affiliative style, physician dominant or controlling style, patient satisfaction, patient confirmation, patient preference for decision making, patient desire for information, and patient age discriminate between patients who agree to participate in clinical trials and patients who refuse to participate. Physicians' affiliative communicative behaviors and patient satisfaction were clearly important to patients who agreed to participate. Motivations for patients who declined to participate in trials were less clear. Implications for physicians who offer clinical trials to their patients are that specific communication skills may enhance their patients' satisfaction and may help increase enrollment in clinical trials.     

A process evaluation of an intervention to improve respiratory infection control practices in family physician offices

OBJECTIVE: To conduct a process evaluation of a short-term intervention by public nurses for physicians to facilitate the incorporation of new respiratory infection control practices in physicians' offices. DESIGN: Process evaluation. Setting: Family physician offices in Ottawa, Ontario, Canada. PARTICIPANTS: Five public health nurse-facilitators and 53 primary care practices including 143 family physicians. METHOD: Effectiveness of facilitator training assessed by self-administered questionnaires. Data assessing process of facilitation collected through activity logs and narrative reports. Physicians' satisfaction assessed by post-intervention questionnaire. MAIN FINDINGS: Facilitators reported that training strongly contributed to their knowledge and skills and all were either satisfied or highly satisfied with their facilitation training. All practices received at least two visits by the facilitator and more than half (51%) were visited three or more times. Facilitators identified the provision of the evidence-based Tool Kit and consensus-building with office staff as key factors contributing to the intervention's success. Of the 45% of physicians who completed the questionnaire (65/143), only 5% reported being somewhat dissatisfied with the intervention, 11% reported the visits were not frequent enough, and 9% thought the visits were too close together. The majority (97%) felt the facilitation program should be available to all family physicians and 98% would continue to use the service if available. CONCLUSIONS: It is feasible for public health nurses to be trained in outreach facilitation to improve respiratory infection control practices in physicians' offices and this has been widely appreciated by physicians. This model of public health/primary care collaboration deserves further exploration.     

Developing an automated speech-recognition telephone diabetes intervention.

OBJECTIVE: Many patients do not receive guideline-recommended care for diabetes and other chronic conditions. Automated speech-recognition telephone outreach to supplement in-person physician-patient communication may enhance patient care for chronic illness. We conducted this study to inform the development of an automated telephone outreach intervention for improving diabetes care among members of a large, not-for-profit health plan. DESIGN: In-depth telephone interviews with qualitative analysis. SETTING: participants Individuals with diabetes (n=36) enrolled in a large regional health plan in the USA. Main outcome measure Patients' opinions about automated speech-recognition telephone technology. RESULTS: Patients who were recently diagnosed with diabetes and some with diabetes for a decade or more expressed basic informational needs. While most would prefer to speak with a live person rather than a computer-recorded voice, many felt that the automated system could successfully supplement the information they receive from their physicians and could serve as an integral part of their care. Patients suggested that such a system could provide specific dietary advice, information about diabetes and its self-care, a call-in menu of information topics, reminders about laboratory test results and appointments, tracking of personal laboratory results and feedback about their self-monitoring. CONCLUSIONS: While some patients expressed negative attitudes toward automated speech recognition telephone systems generally, most felt that a variety of functions of such a system could be beneficial to their diabetes care. In-depth interviews resulted in substantive input from health plan members for the design of an automated telephone outreach system to supplement in-person physician-patient communication in this population.     

Visit-specific expectations and patient-centered outcomes: a literature review

BACKGROUND: Primary care patients often have certain expectations when visiting physicians, many of which may be undetected. These unmet expectations can affect outcomes such as satisfaction with care. We performed a formal literature review to examine the effect of fulfillment of patients' visit-specific expectations on their satisfaction as well as on health status and compliance. PATIENTS AND METHODS: Included studies were conducted in primary care settings, systematically recruited patients, elicited previsit and/or postvisit expectations relative to specific visits, and measured patient-centered outcomes. Two reviewers abstracted information on study characteristics; types, timing, and method of expectation ascertainment; and outcomes. Disagreements were resolved by consensus. RESULTS: Twenty-three studies were reviewed including 7 trials, 4 cohort studies, and 12 cross-sectional studies. Patients frequently expected information rather than specific physician actions, but physicians often did not accurately perceive patients' visit-specific expectations. In 19 studies that assessed postvisit patient satisfaction, a positive association between meeting patient expectations and overall satisfaction was demonstrated in 11 studies, inconclusive in 3, and not established in 5. In 2 studies assessing physician satisfaction, physicians with access to patients' expectations were more satisfied than those without access. Other outcomes (symptom or disease improvement, health status, test ordering, health care costs, psychological symptoms) were measured in only a few studies, and the results were inconclusive. CONCLUSIONS: Addressing patients' visit-specific expectations appears to affect satisfaction to a modest degree. Future studies should evaluate methods that efficiently elicit, prioritize, and provide patients' previsit expectations for physicians and should examine the longitudinal effect of expectation fulfillment on patient outcomes. Arch Fam Med. 2000;9:1148-1155     

Does patient partnership in continuing medical education (CME) improve the outcome in osteoporosis management?

INTRODUCTION: There is an apparent gap between physicians' knowledge and their practical application of such knowledge. Educating patients to educate physicians toward improved care has been shown to be effective in selected settings. This study describes the influence of an active community education program on changing physician behavior. METHODS: A total of 672 schoolteachers were interviewed and screened for detection of osteoporosis risk factors. The teachers were educated about osteoporosis and the significance of bone mass densitometry (BMD) in its management and returned to their physicians with the results of their screening. One group of their physicians received didactic lectures on the results of the screening and the impact of appropriate management on the outcome of osteoporosis. The second group of physicians did not. Six months after the initial interview and screening, patients received a mailed survey. RESULTS: After 6 months, 258 of the teachers who had visited their physicians were resurveyed. The percentage of BMD tests ordered by physicians rose from 8.6% to 33% in both the intervention and control physician groups. Findings at the 6-month survey indicated that physicians initiated the osteoporosis discussion an average of 18% of the visits and patients did an average of 60%, prompting the physician to order a BMD test. DISCUSSION: In this study, there was no evidence that didactic lectures affect physician behavior in ordering BMD. There were, however, compelling indications that patient education, which included written screening results, enhanced physician-patient dialogue, resulting in more BMD orders.     

Comparison of patient satisfaction with ambulatory visits in competing health care delivery settings in Geneva, Switzerland.

OBJECTIVES: To measure satisfaction with medical visits in various health care settings and to assess the extent to which differences in satisfaction scores between health care settings can be attributed to patients' characteristics. DESIGN: This was a cross sectional survey to measure seven dimensions of patient satisfaction. SETTINGS: Ambulatory visits to 'gatekeepers' or specialists in a newly established managed care organisation, a private group practice, or a university hospital outpatient clinic in Geneva, Switzerland. PATIENTS: There were altogether 1027 adult patients (81% participation rate). RESULTS: Patients who consulted physicians in the private group practice reported higher levels of satisfaction (overall mean 83.2 on a scale between 0 and 100) than university clinic patients (79.7), patients of independent specialists within the managed plan (78.5), and patients of managed plan gatekeepers (69.8, intergroup differences p < 0.001). Differences between settings were reduced after adjustment for sex, age, country of origin, general practitioner versus specialist visit, and scheduled versus urgent visit (adjusted scores: 80.8, 78.8, 77.6, and 72.7 in the four settings, p < 0.001). Intergroup differences were largest for general satisfaction, but small and non-significant for satisfaction with explanations given by the physician and for time spent with the patient. CONCLUSIONS: Patient satisfaction varied widely between health care settings. Differences in satisfaction ratings could be ascribed only partly to disparities in patient populations. Patients of managed plan gatekeepers were least satisfied, presumably because they could not choose their physician freely. Comparison of patient satisfaction across health care settings can provide a basis for targeted quality improvement initiatives.     

Direct observation of smoking cessation activities in primary care practice

OBJECTIVE: Our goals were to determine how often family physicians incorporate smoking cessation efforts into routine office visits and to examine the effect of patient, physician, and office characteristics on the frequency of these efforts. STUDY DESIGN: Data was gathered using direct observation of physician-patient encounters, a survey of physicians, and an on-site examination of office systems for supporting smoking cessation. POPULATION: We included patients seen for routine office visits in 38 primary care physician practices. OUTCOMES MEASURED: The frequency of tobacco discussions among all patients, the extent of these discussions among smokers, and the presence of tobacco-related systems and policies in physicians' offices were measured. RESULTS: Tobacco was discussed during 633 of 2963 encounters (21%; range among practices = 0%-90%). Discussion of tobacco was more common in the 58% of practices that had standard forms for recording smoking status (26% vs 16%; P=.01). Tobacco discussions were more common during new patient visits but occurred less often with older patients and among physicians in practice more than 10 years. Of 244 smokers identified, physicians provided assistance with smoking cessation for 38% (range among practices = 0%-100%). Bupropion and nicotine-replacement therapy were discussed with smokers in 31% and 17% of encounters, respectively. Although 68% of offices had smoking cessation materials for patients, few recorded tobacco use in the "vital signs" section of the patient history or assigned smoking-related tasks to nonphysician personnel. CONCLUSIONS: Smoking cessation practices vary widely in primary care offices. Strategies are needed to assist physicians with incorporating systematic approaches to maximize smoking cessation rates.     

Addressing the unique challenges of inner-city practice: a direct observation study of inner-city, rural, and suburban family practices

Previous research on geographic variations in health care contains limited information regarding inner-city medical practice compared with suburban and rural settings. Our main objective was to compare patient characteristics and the process of providing medical care among family practices in inner-city, suburban, and rural locations. A cross-sectional multimethod study was conducted emphasizing direct observation of out patient visits by trained research nurses involving 4, 454 consecutive patients presenting for outpatient care to 138 family physicians during 2 days of observation at 84 community family practices in northeast Ohio. Time use during office visits was assessed with the Davis Observation Code; satisfaction was measured with the Medical Outcomes Study nine-item Visit Rating Scale; delivery of preventive services was as recommended by the US Preventive Services Task Force; and patient-reported domains of primary care were assessed with the Components of Primary Care Instrument. Results show that inner-city patients had more chronic medical problems, more emotional problems, more problems evaluated per visit, higher rates of health habit counseling, and longer and more frequent office visits. Rural patients were older, more likely to be established with the same physician, and had higher rates of satisfaction and patient-reported physician knowledge of the patient. Suburban patients were younger, had fewer chronic medical problems, and took fewer medications chronically. Inner-city family physicians in northeast Ohio appear to see a more challenging patient population than their rural and suburban counterparts and have more complex outpatient office visits. These findings have implications for health system organization along with the reimbursement and recruitment of physicians in medically underserved inner-city areas.     

Patient satisfaction with migraine management by family physicians

Over 70% of the estimated 5 million office visits per year for migraine headache are to family physicians. Both the number of visits and proportion of migraine patients seeking medical care are increasing rapidly. Patient satisfaction with migraine care by primary care physicians is reported to be low but most data are obtained from patients referred to subspecialists or entered in clinical trials. We surveyed patients who consulted family physicians in 10 Kansas practices during 2002 to assess patient satisfaction and investigate any differences between satisfied and unsatisfied migraine patients. Of our 447 respondents, 74% were "satisfied" or "very satisfied" with migraine care by family physicians. Dissatisfied patients were significantly more likely to report moderate or severe migraine-related disability and less likely to use triptans or to have most medications paid by insurance. Dissatisfied patients were twice as likely to have discontinued taking triptans than satisfied patients. Patient satisfaction with migraine treatment in family practice is substantially higher than generally reported. Statistically significant differences exist between satisfied and dissatisfied patients.     

A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators

This trial compared 3 post-hospitalization nursing care models for reducing congestive heart failure (CHF) readmission charges during 180-days of follow-up. Subjects received in-person visits at baseline and 60 days plus 1 of 3 care modalities in the interim: (a) video-based home telecare; (b) telephone calls; and (c) usual care. CHF-related readmission charges were > 80% lower in the telenursing groups compared to usual care, and these groups also had significantly fewer CHF-related emergency visits. In-person visits were more than 3 times longer than telenursing visits (p < 0.0001), only partially due to added travel time. Patient self-care adherence, medications, health status, and satisfaction did not significantly differ between groups. Telenursing can reduce CHF hospitalizations and allow increased frequency of communication with patients.