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Aranda-Lara JM, Acera SM. [Incorporation of telephone care into the provision of primary care and its effects on patient health and satisfaction: Proposal]. Semergen 2021; 48:129-136. [PMID: 34148783 DOI: 10.1016/j.semerg.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
We present a review, analysis and proposal for the implantation, development and evaluation of telephone attention in primary care, focused as a new modality of offer that responds to standardized requirements of safety, efficacy, efficiency and balance not always easy to achieve, between the interests of users and professionals.
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Affiliation(s)
- J M Aranda-Lara
- Consejería de Salud y Familias, Delegación Territorial de Salud y Familias en Córdoba, Córdoba, España.
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Newbould J, Ball S, Abel G, Barclay M, Brown T, Corbett J, Doble B, Elliott M, Exley J, Knack A, Martin A, Pitchforth E, Saunders C, Wilson ECF, Winpenny E, Yang M, Roland M. A ‘telephone first’ approach to demand management in English general practice: a multimethod evaluation. Health Serv Deliv Res 2019. [DOI: 10.3310/hsdr07170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The increasing difficulty experienced by general practices in meeting patient demand is leading to new approaches being tried, including greater use of telephone consulting.
Objectives
To evaluate a ‘telephone first’ approach, in which all patients requesting a general practitioner (GP) appointment are asked to speak to a GP on the telephone first.
Methods
The study used a controlled before-and-after (time-series) approach using national reference data sets; it also incorporated economic and qualitative elements. There was a comparison between 146 practices using the ‘telephone first’ approach and control practices in England with regard to GP Patient Survey scores and secondary care utilisation (Hospital Episode Statistics). A practice manager survey was used in the ‘telephone first’ practices. There was an analysis of practice data and the patient surveys conducted in 20 practices using the ‘telephone first’ approach. Interviews were conducted with 43 patients and 49 primary care staff. The study also included an analysis of costs.
Results
Following the introduction of the ‘telephone first’ approach, the average number of face-to-face consultations in practices decreased by 38% [95% confidence interval (CI) 29% to 45%; p < 0.0001], whereas there was a 12-fold increase in telephone consultations (95% CI 6.3-fold to 22.9-fold; p < 0.0001). The average durations of consultations decreased, which, when combined with the increased number of consultations, we estimate led to an overall increase of 8% in the mean time spent consulting by GPs, although there was a large amount of uncertainty (95% CI –1% to 17%; p = 0.0883). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload. Comparing ‘telephone first’ practices with control practices in England in terms of scores in the national GP Patient Survey, there was an improvement of 20 percentage points in responses to the survey question on length of time to get to see or speak to a doctor or nurse. Other responses were slightly negative. The introduction of the ‘telephone first’ approach was followed by a small (2%) increase in hospital admissions; there was no initial change in accident and emergency (A&E) department attendance, but there was a subsequent small (2%) decrease in the rate of increase in A&E attendances. We found no evidence that the ‘telephone first’ approach would produce net reductions in secondary care costs. Patients and staff expressed a wide range of both positive and negative views in interviews.
Conclusions
The ‘telephone first’ approach shows that many problems in general practice can be dealt with on the telephone. However, the approach does not suit all patients and is not a panacea for meeting demand for care, and it is unlikely to reduce secondary care costs. Future research could include identifying how telephone consulting best meets the needs of different patient groups and practices in varying circumstances and how resources can be tailored to predictable patterns of demand.
Limitations
We acknowledge a number of limitations to our approach. We did not conduct a systematic review of the literature, data collected from clinical administrative records were not originally designed for research purposes and for one element of the study we had no control data. In the economic analysis, we relied on practice managers’ perceptions of staff changes attributed to the ‘telephone first’ approach. In our qualitative work and patient survey, we have some evidence that the practices that participated in that element of the study had a more positive patient experience than those that did not.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jennifer Newbould
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Sarah Ball
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Gary Abel
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Matthew Barclay
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tray Brown
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jennie Corbett
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Brett Doble
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Josephine Exley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | | | - Adam Martin
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Emma Pitchforth
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Catherine Saunders
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Edward CF Wilson
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Eleanor Winpenny
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Miaoqing Yang
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, UK
| | - Martin Roland
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Peleg R, Nazarenko E. Providing cell phone numbers and e-mail addresses to patients: The patient's perspective, a cross sectional study. Isr J Health Policy Res 2012; 1:32. [PMID: 22929801 PMCID: PMC3441808 DOI: 10.1186/2045-4015-1-32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/29/2012] [Indexed: 12/19/2022] Open
Abstract
Background Today patients can consult with their treating physician by cell phone or e-mail. These means of communication enhance the quality of medical care and increase patient satisfaction, but they can also impinge on physicians’ free time and their patient schedule while at work. The objective of this study is to assess the attitudes and practice of patients on obtaining the cell phone number or e-mail address of their physician for the purpose of medical consultation. Methods Personal interviews with patients, 18 years of age or above, selected by random sampling from the roster of adults insured by Clalit Health Services, Southern Division. The total response rate was 41%. The questionnaire included questions on the attitude and practice of patients towards obtaining their physician’s cell phone number or e-mail address. Comparisons were performed using Chi-square tests to analyze statistically significant differences of categorical variables. Two-tailed p values less than 0.05 were considered statistically significant, with a power of 0.8. Results The study sample included 200 patients with a mean age of 46.6 ± 17.1, of whom 110 were women (55%). Ninety-three (46.5%) responded that they would be very interested in obtaining their physician’s cell phone number, and an additional 83 (41.5%) would not object to obtaining it. Of the 171 patients (85.5%) who had e-mail addresses, 25 (14.6%) said they would be very interested in obtaining their physician’s e-mail address, 85 (49.7%) said they would not object to getting it, and 61 (35.7%) were not interested. In practice only one patient had requested the physician’s e-mail address and none actually had it. Conclusions Patients favored cell phones over e-mail for consulting with their treating physicians. With new technologies such as cell phones and e-mail in common use, it is important to determine how they can be best used and how they should be integrated into the flow of clinical practice.
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Affiliation(s)
- Roni Peleg
- Clalit Health Services, Southern District, and the Department of Family Medicine, Siaal Research Center, Faculty of Health Sciences, Ben-Gurion University, POB 653, Beer-Sheva, 84105, Israel.
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Peleg R, Avdalimov A, Freud T. Providing cell phone numbers and email addresses to Patients: the physician's perspective. BMC Res Notes 2011; 4:76. [PMID: 21426591 PMCID: PMC3076270 DOI: 10.1186/1756-0500-4-76] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/23/2011] [Indexed: 12/02/2022] Open
Abstract
Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%). Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007). They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001). More physicians (79.7%) would have preferred allotted time for email communication than allotted time for cell phone communication (50%). However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001). There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039). Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.
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Affiliation(s)
- Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Hewitt H, Gafaranga J, McKinstry B. Comparison of face-to-face and telephone consultations in primary care: qualitative analysis. Br J Gen Pract 2010; 60:e201-12. [PMID: 20423575 PMCID: PMC2858552 DOI: 10.3399/bjgp10x501831] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/06/2010] [Accepted: 01/28/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is evidence that telephone consultations in general practice are typically shorter than face-to-face consultations and that fewer problems are presented in them. AIM To compare the communicative practices of doctors and patients in face-to-face and telephone consultations, in order to understand the contrasts between the two consulting modes. DESIGN OF STUDY Conversation analysis. SETTING Eight NHS GP surgeries in Scotland. METHOD Transcription and conversation analysis of 32 face-to-face and 33 telephone consultations. PARTICIPANTS Eighteen GPs and 65 patients. RESULTS There are no underlying contrasts between the communicative practices used in face-to-face and telephone consultations. Telephone consultations are typically used by patients to deal with a limited range of single-issue concerns, whereas a wide range of different problem types is dealt with in face-to-face consultations. Most telephone consultations for new problems lead to a face-to-face meeting rather than a diagnosis, making them shorter than equivalent face-to-face consultations. Interaction in telephone consultations is continuous and orderly, but in face-to-face consultations there are periods of silence that facilitate the introduction of additional topics, including social speech and rapport building. Doctors on the telephone are less likely to elicit additional concerns than in face-to-face consultations, and ask fewer questions when patients present self-diagnosed problems or describe problems with treatment. CONCLUSION Doctors in general practice do not substantially change their communicative behaviour on the telephone. Telephone consultations are shorter and include less problem disclosure than face-to-face meetings, partly because they are typically mono-topical and partly because of intrinsic differences between the two channels.
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Affiliation(s)
- Heather Hewitt
- Centre for Population Health Sciences: General Practice Section, University of Edinburgh Medical School, Teviot Place, Edinburgh, UK.
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McKinstry B, Watson P, Pinnock H, Heaney D, Sheikh A. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract 2009; 59:e209-18. [PMID: 19520019 PMCID: PMC2688070 DOI: 10.3399/bjgp09x420941] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 10/07/2008] [Accepted: 12/11/2008] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Internationally, there is increasing use of telephone consultations, particularly for triaging requests for acute care. However, little is known about how this mode of consulting differs from face-to-face encounters. AIM To understand patient and healthcare-staff perspectives on how telephone consulting differs from face-to-face consulting in terms of content, quality, and safety, and how it can be most appropriately incorporated into routine health care. DESIGN OF STUDY Focus groups triangulated by a national questionnaire. SETTING Primary care in urban and rural Scotland. METHOD Fifteen focus groups (n = 91) were conducted with GPs, nurses, administrative staff, and patients, purposively sampled to attain a maximum-variation sample. Findings were triangulated by a national questionnaire. RESULTS Telephone consulting evolved in urban areas mainly to manage demand, while in rural areas it developed to overcome geographical problems and maintain continuity of care for patients. While telephone consulting was generally seen to provide improved access, clinicians expressed strong concerns about safety potentially being compromised, largely as a result of lack of formal and informal examination. Concerns were, to an extent, allayed when clinicians and patients knew each other well. CONCLUSION Used appropriately, telephone consulting enhances access to health care, aids continuity, and saves time and travelling for patients. The current emphasis on use for acute triage, however, worried clinicians and patients. Given these findings, and until the safe use of telephone triage is fully understood and agreed upon by stakeholders, policymakers and clinicians should consider using the telephone primarily for managing follow-up appointments when diagnostic assessment has already been undertaken.
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Affiliation(s)
- Brian McKinstry
- Centre of Population Health Sciences: General Practice Section, University of Edinburgh, Edinburgh, Scotland.
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Micevska M. Telecommunications, Public Health, and Demand for Health-Related Information and Infrastructure. Information Technologies and International Development 2005. [DOI: 10.1162/1544752054782466] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Sufficient time and effective communication are the main requirements in an ideal asthma consultation. One way of using limited time effectively is for patients to be offered more information prior to the consultation. Physician-patient communication during the consultation may be improved by patients receiving, in advance, pertinent information related to their appointment and leaflets may be used to encourage patients to list any questions, fears or concerns prior to the consultation. Directing patients to appropriate internet sites may also facilitate information transfer. Time is frequently wasted when patients fail to attend their consultation. Sending a reminder letter or phoning to remind patients of their appointment has been shown to significantly reduce non-attendance rates. During the consultation, time can be used more effectively by ensuring that patients understand their treatment regimens, by improving communication between the doctor and patient and by organising asthma services in a manner acceptable to patients; this includes avoiding delays, having a doctor that listens and seeing the same doctor on each occasion. After the consultation, advice given to patients should be reinforced as studies suggest that patients' ability to recall information given to them may influence patient adherence and patient satisfaction. The whole professional team should be involved in order to manage better limited time effectively and information given to patients should be reinforced, either by post-consultation leaflet/letter or via telephone or email. Most importantly, correct performance of the inhalation manoeuvre should be regularly checked, patients should be taught and trained how to manage their own condition and should be offered convenient follow-up options, all of which should improve patient satisfaction and compliance.
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Affiliation(s)
- Martyn R Partridge
- Respiratory Health Services Research Group, Imperial College London, NHLI at Charing Cross Hospital, London, UK.
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Partridge MR. An assessment of the feasibility of telephone and email consultation in a chest clinic. Patient Educ Couns 2004; 54:11-13. [PMID: 15210254 DOI: 10.1016/s0738-3991(03)00166-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Revised: 04/05/2003] [Accepted: 04/27/2003] [Indexed: 05/24/2023]
Abstract
One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.
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Affiliation(s)
- Martyn R Partridge
- Department of Respiratory Medicine, Faculty of Medicine, NHLI Division, Imperial College London, Charing Cross Campus, St. Dunstans Road, London W6 8RP, UK.
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