Health beat: Care guides just what doctor ordered

Five years ago, Dr. Richard Adair had what some might find a peculiar idea: Hire a cadre of personable but inexperienced workers, place them in medical clinics, and have them counsel chronically ill patients to help improve their health and cut their medical costs.

After a pilot program in 2008, Allina Health clinics in the Twin Cities launched a yearlong study funded primarily by the nonprofit Robina Foundation.

The results were reported this month in the Annals of Internal Medicine.

In short, the experiment worked.

More than 2,100 adults with hypertension, diabetes, heart failure or some combination of those diseases participated. About two-thirds were assigned to the novice "care guides," and each patient was given three to 12 health goals, depending on the diagnosis.

Care guides took time to explain the benefits of meeting health goals in plain language, and were encouraged to focus on patients who appeared motivated. They followed up with phone calls and face-to-face meetings, and worked with doctors to develop specific plans to keep patients on track.

After a year, patients who worked with care guides had reduced their unmet goals by 30.1 percent, compared to 12.6 percent among those who received standard care alone. Those who worked with the care guides did better regardless of their diagnosis and regardless of their race, sex, age, language or education.

Care guides oversaw an average of 120 patients each, but figured they could handle as many as 190 if they didn't have research duties. In that case, care guides would cost an average of about $286 a year per patient.

Some critics worry that care guides lack the training and experience to spot warning signs. Even so, the study found overall that persistent human contact can improve health and cut costs.