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Haimi M, Wheeler SQ. Safety in Teletriage by Nurses and Physicians in the United States and Israel: Narrative Review and Qualitative Study. JMIR Hum Factors 2024; 11:e50676. [PMID: 38526526 PMCID: PMC11002740 DOI: 10.2196/50676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/25/2023] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND The safety of telemedicine in general and telephone triage (teletriage) safety in particular have been a focus of concern since the 1970s. Today, telehealth, now subsuming teletriage, has a basic structure and process intended to promote safety. However, inadequate telehealth systems may also compromise patient safety. The COVID-19 pandemic accelerated rapid but uneven telehealth growth, both technologically and professionally. Within 5-10 years, the field will likely be more technologically advanced; however, these advances may still outpace professional standards. The need for an evidence-based system is crucial and urgent. OBJECTIVE Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. METHODS We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems' respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. RESULTS The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. Researchers, possibly unfamiliar with this complicated field, use an array of poorly defined terms and appear to design studies based on unfounded assumptions. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering nonmedical factors and patient preferences (shared decision-making). CONCLUSIONS Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. This underregulated subspecialty lacks adequate development and substantive research on system safety. Research may commingle terminology and widely different, ill-defined groups of decision makers with wide variation in decision-making skills, clinical training, experience, and job qualifications, thereby confounding results. The rapid pace of telehealth's technological growth creates urgency in identifying safe systems to guide developers and clinicians about needed improvements.
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Affiliation(s)
- Motti Haimi
- Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Health Systems Management Department, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Meuhedet Healthcare Services - North District, Tel Aviv, Israel
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Lee J, Son HK. Effects of simulation problem-based learning based on Peplau's Interpersonal Relationship Model for cesarean section maternity nursing on communication skills, communication attitudes and team efficacy. NURSE EDUCATION TODAY 2022; 113:105373. [PMID: 35468458 PMCID: PMC9371470 DOI: 10.1016/j.nedt.2022.105373] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/15/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In the coronavirus disease-impacted era, many medical institutions have not permitted clinical practice at hospitals or have operated their training on a restricted basis. The effective strategy for improving therapeutic communication and team cooperation as a nursing core competency is required. OBJECTIVES The study aimed to verify the effects of simulation problem-based learning on nursing students' communication skills, communication attitudes, and team efficacy. DESIGN Non-equivalent control group pretest-posttest design. SETTINGS A university in South Korea. PARTICIPANTS Nursing students who were classified as advanced beginners were randomly allocated to the control group (n = 46) or the experimental group (n = 47). METHODS The experimental group's students participated in the simulation problem-based learning for cesarean section maternity nursing. The control group's students participated in a conventional type of maternity nursing clinical practice. The communication skills, communication attitudes, and team efficacy were measured by using a self-reported questionnaire. RESULTS As compared with the pretest, the communication attitudes increased significantly (t = 2.41, p = .020) in the posttest for the experimental group. The communication skills (t = 1.47, p = .150) and team efficacy (F = 3.30, p = .073) were not statistically significant. CONCLUSIONS The simulation problem-based learning in clinical practice is recommended to improve communication attitudes for nursing students and to apply the learned knowledge in simulated nursing situations through experiential learning. Future research is particularly needed the standardized educational program to identify the long-term effects in various cases and settings.
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Affiliation(s)
- Jeongim Lee
- Department of Nursing, Eulji University, Seongnam city 13135, Republic of Korea
| | - Hae Kyoung Son
- Department of Nursing, Eulji University, Seongnam city 13135, Republic of Korea.
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Davies L, Hinman RS, Russell T, Lawford B, Bennell K. An international core capability framework for physiotherapists delivering telephone-based care. J Physiother 2022; 68:136-141. [PMID: 35283052 DOI: 10.1016/j.jphys.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/22/2021] [Accepted: 02/14/2022] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the core capabilities that physiotherapists need in order to deliver quality telephone-based care? DESIGN Three-round modified e-Delphi survey. PARTICIPANTS An international Delphi panel comprising experts in the field, including consumers, physiotherapy researchers, physiotherapy clinicians and representatives of physiotherapy organisations. METHODS A modified e-Delphi survey was conducted. A draft framework was adapted from a previously developed core capability framework for physiotherapists delivering care via videoconferencing. The panel considered the draft framework of 39 individual capabilities across six domains. Over three rounds, panellists rated their agreement (via Likert or 0-to-10 numerical rating scales) on whether each capability was essential (core) for physiotherapists to deliver telephone-based care. Capabilities achieving consensus, defined as 75% of the panel rating the item at least 7 out of 10 in Round 3, were retained. RESULTS Seventy-one panellists from 17 countries participated in Round 1, with retention of 89% in Round 2 and 82% in Round 3. The final framework comprised 44 capabilities across six domains: compliance (n = 7 capabilities); patient privacy and confidentiality (n = 4); patient safety (n = 7); telehealth delivery (n = 9); assessment and diagnosis (n = 7); and care planning and management (n = 10). CONCLUSION This framework outlines the core capabilities that physiotherapists need to provide telephone-based care. It can help inform content of physiotherapy curricula and professional development initiatives in telehealth delivery and provide guidance for physiotherapists providing care over the telephone.
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Affiliation(s)
- Luke Davies
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Trevor Russell
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Belinda Lawford
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia.
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Shahabi N, Kolivand M, Salari N, Abbasi P. The effect of telenursing training based on family-centered empowerment pattern on compliance with diet regimen in patients with diabetes mellitus type 2: a randomized clinical trial. BMC Endocr Disord 2022; 22:36. [PMID: 35139832 PMCID: PMC8830007 DOI: 10.1186/s12902-022-00953-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/03/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Telenursing facilitates access to efficient care and acceptance and compliance with treatment at home. Given wide complications of lack of compliance with treatment in causing complications and progression of diabetes and role of the family in attending the patient, this study aimed to investigate the effect of telenursing training based on family-centered empowerment pattern on compliance with diet regimen in patients with diabetes mellitus type 2. METHODS This was a randomized controlled clinical trial. The study population was patients with diabetes mellitus type 2 referred to Alzhara hospital at Gilan Gharb in 2019, of which 60 individuals out of them were classified randomly into two groups of intervention and control. Eight 30-min sessions of family-centered training were held through telenursing for the intervention group. Data were gathered before and after the intervention by standard questionnaire of Mudanlo in both groups and was analyzed using SPSS software version 22. RESULTS There was no significant difference among the two intervention and control groups before the study regarding demographic variables (p > 0.05). The scores of subscales of making effort for treatment, intention to take the treatment, adaptability, integrating illness into life, stick to the treatment, indecisiveness for applying treatment, and total score of compliance were significantly increased after training intervention (p = 0.001). CONCLUSIONS Results of the study indicates positive effects of performing family-centered empowerment pattern using telephone call follow-up on increasing compliance with diet regimen in patients. Therefore, it is recommended to perform family-centered patterns in health policy-makings and also hospitals and other diabetic patients.
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Affiliation(s)
- Negar Shahabi
- Department of Nursing, Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Kolivand
- Department of Midwifery, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Salari
- Department of Biostatistics, School of Nursing & Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parvin Abbasi
- Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Catalan-Matamoros D, Lopez-Villegas A, Leal Costa C, Bautista-Mesa R, Robles-Musso E, Rocamora Perez P, Lopez-Liria R. A non-randomized clinical trial to examine patients' experiences and communication during telemonitoring of pacemakers after five years follow-up. PLoS One 2021; 16:e0261158. [PMID: 34941904 PMCID: PMC8699982 DOI: 10.1371/journal.pone.0261158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ) was used to assess patients’ experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the ‘Telehealth Patient Satisfaction Survey’ and a ‘costs survey’ was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants’ mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians. Trial registration: ClinicalTrials.gov NCT02234245.
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Affiliation(s)
- Daniel Catalan-Matamoros
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Communication Studies, University Carlos III of Madrid, Madrid, Spain
| | - Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, El Ejido-Almeria, Spain
- * E-mail:
| | | | | | | | - Patricia Rocamora Perez
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - Remedios Lopez-Liria
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
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Gunner CK, Eisner E, Watson AJM, Duncan JL. Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students. MEDICAL EDUCATION ONLINE 2021; 26:1954492. [PMID: 34313579 PMCID: PMC8317946 DOI: 10.1080/10872981.2021.1954492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/17/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. OBJECTIVE To increase final year medical students' video consultation skills and knowledge. METHODS We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. RESULTS The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). CONCLUSIONS The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection.
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Affiliation(s)
| | - Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK AND Research and Innovation Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Angus JM Watson
- Department of Colorectal Surgery, NHS Highland, Inverness, UK
| | - John L. Duncan
- Highlands Medical Education Centre, University of Aberdeen, Inverness, UK
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Mack JA, Morgan HK, Fitzgerald JT, Walford EC, Heidemann LA. The Development of a Video Intervention to Improve Senior Medical Students' Performance on Outpatient Telephone Encounters: a Delphi Analysis and Randomized Controlled Trial. MEDICAL SCIENCE EDUCATOR 2021; 31:1429-1439. [PMID: 34178421 PMCID: PMC8216674 DOI: 10.1007/s40670-021-01331-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
Introduction Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs. Materials and Methods We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement. Results The Delphi yielded 34 important skills with the highest focus on communication (n = 13) and triage (n = 6). Seventy-two students completed assessments (Control, n = 41; Intervention, n = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention. Conclusions This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01331-w.
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Affiliation(s)
- Jacob A. Mack
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, UH South F4323, 1500 E. Medical Center Drive, 48109 Ann Arbor, MI, USA
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - James T. Fitzgerald
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Eric C. Walford
- Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Lauren A. Heidemann
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, UH South F4323, 1500 E. Medical Center Drive, 48109 Ann Arbor, MI, USA
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Beddows J, Abdalla M, Blanchard D, Hammond E, Hay F, Webb M, Protheroe J. 'I'm just ringing to get a repeat prescription for my contraceptive pill, doctor': developing authentic simulated telephone consultations for medical students. EDUCATION FOR PRIMARY CARE 2021; 32:303-307. [PMID: 33890545 DOI: 10.1080/14739879.2021.1915708] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Within normal surgery hours telephone consultations have been previously shown to make up between 10-20% of patient contacts with General Practitioners (GPs) and to comprise a large proportion of a GP's daily workload. Although obviously very useful, such doctor-patient interactions can be fraught with risk. The General Medical Council (GMC) requires that newly graduated doctors should be adaptable to the challenge of delivering treatment advice and management remotely. Yet, currently, there is limited specific training in telephone consultation skills in both undergraduate and postgraduate curricula.Authentic and properly supervised exposure of medical students to GP telephone consultations can be difficult to achieve in clinical placements. Therefore, we have developed emergency telephone consultations within our primary care Safe and Effective Clinical Outcomes (SECO) clinics which are simulated GP surgeries organised for our final year students. We have expanded the range of patients presenting in these clinics by including trained, simulated patients requesting an urgent telephone consultation with a GP. In doing so we aim to enhance our student's skills and confidence in conducting telephone consultations.This teaching exchange paper aims to describe the ideas behind the construction of simulated patient telephone scripts together with the difficulties and successes encountered in introducing telephone consultations into our GP SECO clinic. We hope these ideas and processes will stimulate and enable others to help students prepare for this challenging area of clinical medicine made increasingly significant by the Covid-19 pandemic.
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Affiliation(s)
| | | | | | | | - Fiona Hay
- School of Medicine, Keele University, Keele, UK
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Tayce JD, Coe JB, Creevy KE. Pilot Study of Small Animal Rotating Intern Telephone Communication Training Using Simulated Referring Veterinarians. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:139-144. [PMID: 32412370 DOI: 10.3138/jvme.2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Proficiency in client communications is now widely accepted as a significant requirement of veterinary student education, with numerous training systems in use and documentation of outcomes required for academic accreditation. Little information is available concerning communication training for veterinary house officers (interns and residents), despite the large number of new graduates who enter such programs seeking further training and mentorship. The majority of student communication training focuses on face-to-face interactions with clients and development of core communication skills. By contrast, veterinary house officers in specialty hospitals frequently communicate about cases with practitioner colleagues by telephone, to assess emergent and urgent referrals and follow up on shared cases. Successful telephone communication with these colleagues is a valuable skill to cultivate in novice interns. In this pilot study, self-reported veterinary intern confidence with communication skills improved after a telephone-based simulated referring veterinarian (RDVM) communications training experience. The use of simulated RDVMs, and telephone-based training, shows promise for incorporation into future training experiences of veterinarians at this level.
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Brem BG, Schnabel KP, Woermann U, Hari R, Pless A. "Telephone consultation for medical emergencies" - development, implementation and evaluation of a course in identifying and handling medical emergencies via telephone for 5 th year medical students. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc63. [PMID: 33824899 PMCID: PMC7994869 DOI: 10.3205/zma001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/03/2020] [Accepted: 11/20/2020] [Indexed: 06/12/2023]
Abstract
Objectives: Advising patients seeking medical guidance while communicating with them via telephone is a highly relevant skill in clinical daily life. However, telephone consultations differ from face-to-face interactions: clinical examination is nearly impossible and visual signals cannot be observed. Thus, telephone consultations require specific skills training. This article describes the development, implementation and evaluation of a course, "Telephone Consultation for Medical Emergencies", for 5th year medical students at the University of Bern, Switzerland. Methods: Following the evidence in the literature for telephone consultations, we developed guidelines for effective communication via telephone. After self-study of preparatory material, learners engaged in telephone consultations with simulated patients (SP) at the simulation center. They received multi-dimensional feedback regarding the encounter. Results: The course was successfully implemented in 2012. Evaluations showed the course to be well-received by students. In a survey, students agreed that they had learned many new skills and that they considered this learning as being important in their future employment. They felt that the SP feedback was helpful and that being observed by peer-students during the encounter or filling in a checklist while observing peer-students in other encounters added to their learning. During the debriefing of the simulation with a clinical expert, students judged the scenarios as realistic and relevant, praised the SP performances and identified that the most instructive aspect of the training was the opportunity to practice and to get feedback. Conclusion: Telephone consultations require specific skills that should be trained. The current Covid-19 pandemic and the recommendations of government institutions for patients to contact healthcare professionals primarily via telephone stress the importance of adequately training these skills. In this publication we describe a feasible and viable format for implementing this process.
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Affiliation(s)
| | | | - Ulrich Woermann
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Roman Hari
- University of Bern, Institute of Primary Health Care, Bern, Switzerland
| | - Anina Pless
- University of Bern, Institute of Primary Health Care, Bern, Switzerland
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Collini A, Parker H, Oliver A. Training for difficult conversations and breaking bad news over the phone in the emergency department. Emerg Med J 2020; 38:151-154. [PMID: 33273038 DOI: 10.1136/emermed-2020-210141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/09/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022]
Abstract
Due to the COVID-19 pandemic, there have been strict limits on visitors to hospitals. This has led to clinicians having an increasing number of difficult conversations with patients and their relatives over the phone. There is a lack of published literature examining how to do this well, but it is recognised that phone communication does differ from face to face interactions, and requires specific training. What is most important to patients and their families when receiving bad news is privacy, adequate time without interruptions, clarity and honesty when delivering the information, and an empathetic and caring attitude. Much of the work done on breaking bad news has been done in oncology and focusses on face to face interaction; there has been an assumption that this is transferrable to the emergency department, and more recently that this is applicable to conversations over the phone. Multiple educational interventions to improve the delivery of bad news have been developed, with differing frameworks to help clinicians carry out this stressful task. Simulation is widely used to train clinicians to break bad news, and has solid theoretical foundations for its use. The psychological safety of participants must be considered, especially with emotive subjects such as breaking bad news. We believe there is a need for specific training in breaking bad news over the phone, and developed an innovative simulation-based session to address this. The training has been well received, and has also highlighted the need for a space where clinicians feel able to discuss the emotional impact of the difficult conversations they are having.
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Affiliation(s)
- Anna Collini
- Education Academy, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Helen Parker
- Emergency Department, Newham University Hospital, Barts Health NHS Trust, London, UK
| | - Amy Oliver
- Role Plays for Training (RPfT), London, UK
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Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207678. [PMID: 33096736 PMCID: PMC7589429 DOI: 10.3390/ijerph17207678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.
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Eriksson I, Wilhsson M, Blom T, Broo Wahlström C, Larsson M. Telephone nurses' strategies for managing difficult calls: A qualitative content analysis. Nurs Open 2020; 7:1671-1679. [PMID: 33072350 PMCID: PMC7544854 DOI: 10.1002/nop2.549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/02/2022] Open
Abstract
Aim To describe telenurses' strategies for managing difficult calls. Background Telenursing is a growing and complex area and places great demands on telenurses' knowledge and skills and on their ability to communicate and listen. To become emotionally concerned is central to telenurses' experiences of difficult calls. Design A descriptive qualitative study. Methods The data were collected during February 2017 through individual interviews with 19 telenurses at call centres and primary healthcare centres. Data were analysed with qualitative content analysis. Result The analysis revealed an essential strategy illustrated by the theme “to be calm and secure in themselves.” Further categories described telenurses' strategies to manage difficult calls, labelled as: “to show commitment and interest,” “to have structure in the call and use support systems,” “to pause the call” and “to reflect on difficult calls.” The results show that telenurses need multiple strategies to help them to navigate difficult calls.
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Affiliation(s)
- Irene Eriksson
- School of Health Sciences University of Skövde Skövde Sweden
| | - Marie Wilhsson
- School of Health Sciences University of Skövde Skövde Sweden
| | - Therese Blom
- Primary Child Health Service Care Falköping Sweden
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Mulroy E, Menozzi E, Lees AJ, Lynch T, Lang AE, Bhatia KP. Telemedicine in Movement Disorders: Leçons du COVID-19. Mov Disord 2020; 35:1893-1896. [PMID: 32881108 DOI: 10.1002/mds.28297] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Elisa Menozzi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies, Institute of Neurology, University College London, London, UK
| | - Timothy Lynch
- Centre for Brain Health, Dublin Neurological Institute at the Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movements Disorder Clinic, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
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15
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Abstract
Doctors need to acquire telehealth consultation skills to thrive in the increasingly pressurized health system of delivering high-quality, high-volume health care with a shrinking health care workforce. Telehealth consultations require the same degree of thoroughness and careful clinical judgment as face-to-face consultations. The distinct differences between telehealth and face-to-face consultations warrant training in telehealth, which should be incorporated into core curricula of medical schools and continuing medical education. We describe competency-based training for telehealth piloted with medical residents. The use of competency-based training for telehealth operationalized as an entrustable professional activity will facilitate high-quality, safe, and effective telehealth consultations.
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Affiliation(s)
- Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Australia.
| | - Louise Sandra van Galen
- Department of Internal Medicine, Amsterdam University Medical Center, Location VUmc, De Boelelaan 1117, Room ZH 4A58, 1081 HV Amsterdam, Netherlands. https://twitter.com/GalenLouise
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Level 18, Clinical Sciences Building, 11 Mandalay Road, Singapore 308232, Singapore. https://twitter.com/ejosipcar
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16
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Client Experiences of a Telephone-Delivered Intervention for Alcohol Use: a Qualitative Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00381-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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17
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Chen W, Kempegowda P, Melson E, Davitadze M, Aftab M, Ooi E, Ng CY, Blaggan P, Hanania T, Thomas L, Zhou D, Sankar S, Ayuk J, Karamat MA. Simulation training using WhatsApp (Sim-thru-WhatsApp) improves doctors' confidence in endocrine and diabetes case management. Clin Med (Lond) 2020; 20:s62-s63. [PMID: 32409381 DOI: 10.7861/clinmed.20-2-s62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wentin Chen
- University of Birmingham Medical School, Birmingham, UK
| | | | - Eka Melson
- Institute of Metabolism and Systems Research, Birmingham, UK
| | - Meri Davitadze
- Georgian-American Family Medicine Clinic 'Medical House', Tbilisi, Georgia
| | - Manal Aftab
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Ooi
- RCSI & UCD Malaysia Campus, Pulau Pinang, Malaysia
| | - Cai Ying Ng
- RCSI & UCD Malaysia Campus, Pulau Pinang, Malaysia
| | | | - Thia Hanania
- University of Birmingham Medical School, Birmingham, UK
| | | | - Dengyi Zhou
- University of Birmingham Medical School, Birmingham, UK
| | - Sailesh Sankar
- Health Education England (West Midlands), Birmingham, UK
| | - John Ayuk
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study. BJGP Open 2020; 4:bjgpopen20X101008. [PMID: 32019774 PMCID: PMC7330189 DOI: 10.3399/bjgpopen20x101008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/24/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Primary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees' preparation for, or experiences and perceptions of, them. AIM To understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations. DESIGN & SETTING A mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees. METHOD A cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis. RESULTS The survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R 2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations. CONCLUSION This project sheds light on GP trainees' current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.
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19
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Bromley R, Cock K. Setting up a nurse-led bowel 'two week wait' service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:1063-1068. [PMID: 31518538 DOI: 10.12968/bjon.2019.28.16.1063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients who present to their GP with 'red flag' symptoms for possible bowel cancer (such as change in bowel habit or rectal bleeding) are urgently referred to an acute trust as a '2 week wait' (2WW) patient and require assessment and investigation in an efficient and timely manner. The burden that is created by ever increasing numbers of referrals requires a service that is reliable and flexible in meeting demand. This article presents the development of a nurse-led 2WW service that was implemented as a direct result of this pressure. The development of the national guideline is discussed and the rationale for a nurse-led service is provided, along with the processes followed to ensure patient safety. The inclusion of a telephone side to service provision is also examined and the challenges faced by the team are discussed.
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Affiliation(s)
| | - Karen Cock
- Colorectal Consultant Nurse, Royal Cornwall Hospital, Truro
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20
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van Galen LS, Wang CJ, Nanayakkara PWB, Paranjape K, Kramer MHH, Car J. Telehealth requires expansion of physicians' communication competencies training. MEDICAL TEACHER 2019; 41:714-715. [PMID: 29944031 DOI: 10.1080/0142159x.2018.1481284] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We are in the midst of transformation of health systems where remote consulting (via video, telephone, email, and mobile messaging) is soon to become the dominant mode of consultation. Most of the literature on telehealth omits mentioning the need for telehealth communication competencies. Yet evidence base has been growing about how critical this training is - whether from clinical communication research or litigation claims analysis. In this article, we are calling for an urgent expansion of communication skills curricula to encompass these new telehealth domains from medical schools, specialty trainings to CMEs.
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Affiliation(s)
- L S van Galen
- a Centre for Population Health Sciences, Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | - C J Wang
- c Centre of Policy, Outcomes and Prevention, and Division of General Paediatrics , Stanford University , Stanford , CA , USA
| | - P W B Nanayakkara
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | | | - M H H Kramer
- b Department of Internal Medicine, Section of Acute Medicine , VU University Medical Centre , Amsterdam , The Netherlands
| | - J Car
- a Centre for Population Health Sciences, Lee Kong Chian School of Medicine , Nanyang Technological University , Singapore
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21
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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 SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [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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22
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Lawford BJ, Bennell KL, Campbell PK, Kasza J, Hinman RS. Therapeutic Alliance Between Physical Therapists and Patients With Knee Osteoarthritis Consulting Via Telephone: A Longitudinal Study. Arthritis Care Res (Hoboken) 2019; 72:652-660. [PMID: 30927509 DOI: 10.1002/acr.23890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/26/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To explore therapeutic alliance between physical therapists and patients with knee osteoarthritis during telephone consultations. Specifically, to describe and compare physical therapist and patient ratings, to determine whether alliance changes over time, and to evaluate whether individual characteristics are associated with alliance. METHODS We performed a secondary analysis of 84 patients in the intervention arm of a randomized controlled trial who completed 5-10 consultations with 1 of 8 physical therapists via telephone over 26 weeks, involving education, advice, and prescription of a strengthening and physical activity program. Therapeutic alliance was measured after the second (week 4) and final consultations (week 26), using the Working Alliance Inventory-Short Form. RESULTS Patient and physical therapist ratings of the alliance were high. At week 4, patients rated the overall alliance, and all 3 subscales, higher than therapists. At 26 weeks, patients rated the Task subscale higher than therapists. Patient ratings for the Goal subscale decreased over time, while physical therapist ratings for total alliance and the Bond subscale increased. For patients, the variables of living with others, consulting with a therapist with no previous experience delivering care remotely, having more telephone consultations, and having a higher self-efficacy were associated with greater alliance ratings. Therapists were more likely to perceive a stronger alliance if they had less clinical experience and when treating patients who were younger and had higher self-efficacy. CONCLUSION Physical therapist perceptions of the therapeutic alliance tended to be lower than those of patients early in treatment, but differences were small and of unclear clinical significance. Some subgroups of patients rated the alliance more strongly than others.
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Affiliation(s)
| | - Kim L Bennell
- University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Rana S Hinman
- University of Melbourne, Parkville, Victoria, Australia
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23
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Interprofessional “on-call” e-learning for family nurse practitioner students: Preparing for primary care across the life span. J Am Assoc Nurse Pract 2019; 31:104-109. [DOI: 10.1097/jxx.0000000000000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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John K, Tailor S, Anderson J, Lawthom C. Managing epilepsy in austerity - Evaluating the utility and value of the epilepsy specialist nurse in an open access model of service delivery. Aneurin Bevan Epilepsy Specialist Team (A.B.E.S.T.). Seizure 2019; 65:98-100. [PMID: 30660000 DOI: 10.1016/j.seizure.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Healthcare organisations in the UK primarily measure clinical activity from data collected on numbers of attendances at outpatient clinics, inpatient admissions and procedures performed etc. Telephone contacts with patients are not typically measured as clinical activity. This service evaluation examines the utility and value of the Epilepsy Specialist Nurse (ESN) within an innovative 'Open Access Model', giving a breakdown of clinical workload and outcomes. METHODS A retrospective service evaluation analysing all patient encounters made by the ESN and their outcomes, over a 3-month period from the 01/02/2017 to 30/04/2017. RESULTS During the 3-month data collection period there were 620 patient encounters with 251 different patients. Nurse-led clinic appointments and telephone calls were the two most common types of encounter. Eighteen percent of ESN time was spent on the phone directly addressing patient concerns (368 encounters). Of these calls, 72% led to prevention of a clinic appointment (268 appointments avoided) while only 22% needed a subsequent clinic appointment. The most common outcome of telephone encounters was 'medication management' (25%). CONCLUSIONS The evaluation demonstrates that timely intervention by telephone reduces the need for outpatient appointments and leads to treatment changes being implemented quickly to address individual need.
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Affiliation(s)
- Keri John
- Aneurin Bevan University Health Board, United Kingdom
| | - Sunil Tailor
- School of Medicine, Cardiff University, United Kingdom
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25
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Bailey CM, Newton JM, Hall HG. Telephone triage and midwifery: A scoping review. Women Birth 2018; 31:414-421. [DOI: 10.1016/j.wombi.2017.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/23/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022]
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26
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Morony S, Weir K, Duncan G, Biggs J, Nutbeam D, Mccaffery KJ. Enhancing communication skills for telehealth: development and implementation of a Teach-Back intervention for a national maternal and child health helpline in Australia. BMC Health Serv Res 2018. [PMID: 29514642 PMCID: PMC5842621 DOI: 10.1186/s12913-018-2956-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Telehealth professionals require advanced communication skills, in part to compensate for lack of visual cues. Teach-Back is a best practice communication technique that has been recommended but not previously evaluated for consumer telehealth. We aimed to implement Teach-Back at a national maternal and child health telephone helpline. We describe the intervention and report telenurse experiences learning to use Teach-Back. Methods We identified barriers (time, knowledge, skills, beliefs) and enablers (self-reflection) to using Teach-Back, and developed a novel training program to address these, guided by the Theoretical Domains Framework. We engaged maternal and child health telenurses to participate in a “communication skills” study. The intervention had two key components: guided self-reflection and a Teach-Back skills workshop. For the duration of the 7-week study nurses completed brief online surveys following each call, reflecting on both the effectiveness of their communication and perceived caller understanding. At the end of each shift they reflected on what worked well. Teach-Back knowledge, skills, and beliefs were addressed in a 2-h workshop using videos, discussion, and role play. We explored nurses’ experiences of the intervention in focus groups and interviews; and analysed transcripts and comments from the self-reflection surveys using the Framework method. This study forms part of a larger evaluation conducted in 2016. Results In total 16 nurses participated: 15 were trained in Teach-Back, and 13 participated in focus groups or interviews. All engaged with both self-reflection and Teach-Back, although to differing extents. Those who reported acquiring Teach-Back skills easily limited themselves to one or two Teach-Back phrases. Nurses reported that actively self-reflecting (including on what they did well) was useful both for developing Teach-Back skills and analysing effectiveness of the techniques. Most wanted more opportunity to learn how their colleagues manage Teach-Back in different situations, and more visual reminders to use Teach-Back. Conclusions Our theory-informed intervention successfully enabled nurses to use Teach-Back. Guided self-reflection is a low-resource method aligned with nurse professional identity that can facilitate Teach-Back skills learning, and could also be applied to other advanced communication skills for telehealth. Listening to multiple workplace-specific examples of Teach-Back is recommended for future training. Trial registration ACTRN12616000623493 Registered 15 May 2016. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12913-018-2956-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suzanne Morony
- The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia.
| | - Kristie Weir
- The University of Sydney, Wiser Healthcare, Sydney School of Public Health, Sydney, NSW, Australia
| | - Gregory Duncan
- Eastern Health Clinical School, Medicine, Nursing and Health Sciences, Monash University, Box Hill, Melbourne, VIC, Australia
| | | | - Don Nutbeam
- The University of Sydney, Sydney School of Public Health, Sydney, NSW, Australia
| | - Kirsten J Mccaffery
- The University of Sydney, Sydney Health Literacy Lab, Sydney School of Public Health, Sydney, NSW, Australia
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27
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Lehmann AE, Kozin ED, Sethi RKV, Wong K, Lin BM, Gray ST, Cunningham MJ. Resident responses to after-hours otolaryngology patient phone calls: An overlooked aspect of residency training? Laryngoscope 2017; 128:E163-E170. [PMID: 28782193 DOI: 10.1002/lary.26784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 06/05/2017] [Accepted: 06/08/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Otolaryngology residents are often responsible for triaging after-hours patient calls. However, residents receive little training on this topic. Data are limited on the clinical content, reporting, and management of otolaryngology patient calls. This study aimed to characterize the patient concerns residents handle by phone and their subsequent management and reporting. STUDY DESIGN Retrospective review. METHODS Five hundred consecutive after-hours patient calls in a tertiary pediatric hospital were reviewed. Data collected included patient and caller demographics, clinical concerns, surgical history, recommendations, and subsequent emergency department (ED) visits. RESULTS On average, 3.7 calls occurred per shift, 2.8 on weekday and 5.9 on weekend shifts. Mean patient age was 6.6 years. Mothers (71%) called most frequently. The majority of calls were postoperative (64.2%). Of postoperative calls, most occurred within 3 days of surgery (52.3%). Most calls were for surgical site bleeding (19.9%). Residents recommended ED evaluation for 17.2% of calls, of which 20.9% returned to the primary institution ED. ED evaluation was recommended more frequently for postoperative patients (P = .040), particularly following adenotonsillectomy (51.2%) or surgical site bleeding (18.6%). With respect to documentation, 32.8% of medical record numbers were absent, 11.8% had name errors, and 2.2% of patients could not be identified. CONCLUSIONS This is the first study to analyze the management and reporting of patient calls by otolaryngology residents. A wide array of clinical concerns are triaged by phone conversations. The study has implications for both resident and patient education. LEVEL OF EVIDENCE 4. Laryngoscope, 128:E163-E170, 2018.
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Affiliation(s)
- Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Rosh K V Sethi
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Kevin Wong
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Brian M Lin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Michael J Cunningham
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
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Abstract
OBJECTIVES There is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of this expectation. METHODS We reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosure: the United States, the United Kingdom, Canada, New Zealand, and Australia. RESULTS We identified 5 themes that reflect key challenges to disclosure: (1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure. CONCLUSIONS Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.
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29
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Vaona A, Pappas Y, Grewal RS, Ajaz M, Majeed A, Car J. Training interventions for improving telephone consultation skills in clinicians. Cochrane Database Syst Rev 2017; 1:CD010034. [PMID: 28052316 PMCID: PMC6464130 DOI: 10.1002/14651858.cd010034.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. OBJECTIVES To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. SELECTION CRITERIA We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. MAIN RESULTS We identified one very small controlled before-after study performed in 1989: this study used a validated tool to assess the effects of a training intervention on paediatric residents' history-taking and case management skills. It reported no difference compared to no intervention, but authors did not report any quantitative analyses and could not supply additional data. We rated this study as being at high risk of bias. Based on GRADE, we assessed the certainty of the evidence as very low, and consequently it is uncertain whether this intervention improves clinicians' telephone skills.We did not find any study assessing the effect of training interventions for improving clinicians' telephone communication skills on patient primary outcomes (health outcomes measured by validated tools or biomedical markers or patient behaviours, patient morbidity or mortality, patient satisfaction, urgency assessment accuracy or adverse events). AUTHORS' CONCLUSIONS Telephone consultation skills are part of a wider set of remote consulting skills whose importance is growing as more and more medical care is delivered from a distance with the support of information technology. Nevertheless, no evidence specifically coming from telephone consultation studies is available, and the training of clinicians at the moment has to be guided by studies and models based on face-to-face communication, which do not consider the differences between these two communicative dimensions. There is an urgent need for more research assessing the effect of different training interventions on clinicians' telephone consultation skills and their effect on patient outcomes.
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Affiliation(s)
- Alberto Vaona
- Azienda ULSS 20 ‐ VeronaPrimary CareOspedale di MarzanaPiazzale Ruggero Lambranzi 1VeronaItaly37142
| | - Yannis Pappas
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Rumant S Grewal
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstans RoadLondonLondonUKW6 8RP
| | - Mubasshir Ajaz
- University of BedfordshireInstitute for Health ResearchPark SquareLutonBedfordUKLU1 3JU
| | - Azeem Majeed
- Imperial College LondonDepartment of Primary Care and Public HealthThe Reynolds Building, Charing Cross CampusSt Dunstan's RoadLondonUKW6 8RP
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological UniversityCentre for Population Health Sciences (CePHaS)3 Fusionopolis Link, #03‐08Nexus@one‐northSingaporeSingapore138543
- University of LjubljanaDepartment of Family Medicine, Faculty of MedicineLjubljanaSlovenia
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Dannenberg KA, Stroben F, Schröder T, Thomas A, Hautz WE. The future of practical skills in undergraduate medical education - an explorative Delphi-Study. GMS JOURNAL FOR MEDICAL EDUCATION 2016. [PMID: 27579362 DOI: 10.5061/dryad.q4sc8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of "outcome-orientated training" is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) - the German OF - the "Consensus Statement of Practical Skills in Undergraduate Medical Education" (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the "Clinical-Practical Skills" chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students' graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. METHODOLOGY Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. RESULTS 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. DISCUSSION The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the "Clinical-Practical Skills" NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement.
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Affiliation(s)
- Katja Anne Dannenberg
- Charité - Universitätsmedizin Berlin, Lernzentrum (Skills Lab), Berlin, Germany; Charité - Universitätsmedizin Berlin, Department of Emergency Medicine at Campus Benjamin Franklin, Berlin, Germany
| | - Fabian Stroben
- Charité - Universitätsmedizin Berlin, Lernzentrum (Skills Lab), Berlin, Germany
| | - Therese Schröder
- Charité - Universitätsmedizin Berlin, Gynecology and Obstetrics Clinic, Berlin, Germany
| | - Anke Thomas
- Charité - Universitätsmedizin Berlin, Gynecology and Obstetrics Clinic, Berlin, Germany
| | - Wolf E Hautz
- Inselspital Bern, University Emergency Center, Bern, Switzerland
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Dannenberg KA, Stroben F, Schröder T, Thomas A, Hautz WE. The future of practical skills in undergraduate medical education - an explorative Delphi-Study. GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc62. [PMID: 27579362 PMCID: PMC5003134 DOI: 10.3205/zma001061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/29/2016] [Accepted: 03/16/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND 64% of young medical professionals in Germany do not feel adequately prepared for the practical requirements of the medical profession. The goal of "outcome-orientated training" is to structure medical curricula based on the skills needed when entering the workforce after completing undergraduate medical education, and thus to bridge the gap between the skills graduates have attained and those necessary for a career in the medical profession. Outcome frameworks (OFs) are used for this purpose. In preparation for developing the National Competence-Based Catalogue of Learning Objectives for Medicine (NKLM) - the German OF - the "Consensus Statement of Practical Skills in Undergraduate Medical Education" (which structures the teaching and acquisition of practical skills in Germany and which strongly influenced the "Clinical-Practical Skills" chapter of the NKLM) was published in 2011. It is not uncommon for at least a decade to elapse between the definition and implementation of an OF and the students' graduation, which can further increase the gap between necessary and acquired skills. Thus, the purpose of this paper is to posit theses for future development in healthcare and to apply these theses to a current OF. METHODOLOGY Partially structured interviews with experts were used to generate theses pertaining to general, future development in healthcare. These theses were assessed by physician experts based on the likelihood of implementation by the year 2025. The 288 learning goals of the consensus statement were assessed for their relevance for medical education in the interim. RESULTS 11 theses were generated for the development of medicine, and these theses were assessed and discussed by 738 experts. These theses include the increase in diseases associated with old age, the increasing significance of interprofessional cooperation, and the growing prevalence of telemedicine applications. Of the 288 learning goals of the consensus statement, 231 of the goals were assessed as relevant, and 57 were deemed irrelevant for the short-term future. DISCUSSION The theses on the future of healthcare, which were generated in this study and which were validated by numerous experts, provide indications of future developments of overall requirements for medical school graduates. For example, when applied to the content of the "Clinical-Practical Skills" NKLM chapter, they largely validate the future relevance of developing practical skills while also providing indications for their further development as applied to the consensus statement.
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Affiliation(s)
- Katja Anne Dannenberg
- Charité – Universitätsmedizin Berlin, Lernzentrum (Skills Lab), Berlin, Germany
- Charité – Universitätsmedizin Berlin, Department of Emergency Medicine at Campus Benjamin Franklin, Berlin, Germany
- *To whom correspondence should be addressed: Katja Anne Dannenberg, Charité – Universitätsmedizin Berlin, Lernzentrum (Skills Lab), Charitéplatz 1, D-10117 Berlin, Germany, Phone: +49 (0)30/450-576403, Fax: +49 (0)30/450-576922, E-mail:
| | - Fabian Stroben
- Charité – Universitätsmedizin Berlin, Lernzentrum (Skills Lab), Berlin, Germany
| | - Therese Schröder
- Charité – Universitätsmedizin Berlin, Gynecology and Obstetrics Clinic, Berlin, Germany
| | - Anke Thomas
- Charité – Universitätsmedizin Berlin, Gynecology and Obstetrics Clinic, Berlin, Germany
| | - Wolf E. Hautz
- Inselspital Bern, University Emergency Center, Bern, Switzerland
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Kazeem A, Car J, Pappas Y. Telephone consultations for the management of alcohol-related disorders. Hippokratia 2015. [DOI: 10.1002/14651858.cd009267.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ayodele Kazeem
- Imperial College; Faculty of Med, Epidemiology, Public Health & Primary Care and Social Medicine; 326, Reynolds Building, Charing Cross Campus London UK
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University; Health Services and Outcomes Research Programme; 3 Fusionopolis Link, #03-08 Nexus@one-north Singapore Singapore 138543
| | - Yannis Pappas
- University of Bedfordshire; Institute for Health Research; Park Square Luton Bedford UK LU1 3JU
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Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards DA, Richards SH, Salisbury C, Taylor RS, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Price L, Roscoe J, Varley A, Warren FC. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technol Assess 2015; 19:1-212, vii-viii. [PMID: 25690266 DOI: 10.3310/hta19130] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice. OBJECTIVES In comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice. DESIGN Pragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation. SETTING General practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk). PARTICIPANTS Patients requesting same-day consultations. INTERVENTIONS Practices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation. MAIN OUTCOME MEASURES Primary - primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary - resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care. RESULTS Of 20,990 eligible randomised patients (UC n = 7283; GPT n = 6695; NT n = 7012), primary outcome data were analysed for 16,211 patients (UC n = 5572; GPT n = 5171; NT n = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient-clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it. CONCLUSIONS Introducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented. TRIAL REGISTRATION Current Controlled Trials ISRCTN20687662. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Colin Green
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Tim Holt
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Valerie Lattimer
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - David A Richards
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Raff Calitri
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Vicky Bowyer
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Chaplin
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Rebecca Kandiyali
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Jamie Murdoch
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Linnie Price
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Julia Roscoe
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Varley
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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Fisher J, Martin R, Tate D. Hands on + hands free: simulated on-call interaction. CLINICAL TEACHER 2015; 11:425-8. [PMID: 25212926 DOI: 10.1111/tct.12180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In hospital, doctors and nurses frequently discuss acutely unwell patients via the telephone. Telephone communication can be challenging, yet medical students receive little training in how to conduct such interactions. We aimed to provide a simple, innovative, simulation session to address this learning need for third-year medical students at Newcastle University. METHODS Groups of students were given a pager and a supervising tutor. Students responded to a 'bleep' from a nurse practitioner in a different room, who role-played a ward nurse concerned about a patient. Speakerphones were used, allowing the entire conversation to be audible. After the call, a student-led debriefing session took place. After the debriefing another student 'held' the bleep and a different scenario ensued. Following a resuscitation scenario, students made telephone contact with the medical registrar to hand over information pertaining to the case. Before and after the session, students rated their confidence in telephone interaction and handover using a 10-point Likert scale. Students also completed a feedback questionnaire. RESULTS Fifty-four students attended the session. A statistically significant improvement in student confidence in telephone communication and handover was seen after the session. Free-text feedback highlighted that students had not received teaching on this previously, and that they welcomed opportunities to practise such skills within a controlled, safe environment. DISCUSSION Simulation training can be costly, but speakerphones are cheap and readily available. Given the frequency of telephone interaction in hospital, we believe all medical students should receive telephone communication training. Locally, our department has now incorporated these teaching methods into simulation sessions elsewhere in the curriculum. Medical students receive little training in how to conduct [telephone] interactions.
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Affiliation(s)
- James Fisher
- North Tyneside General Hospital, North Shields, UK
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Das BJ, Saikia BN, Baruah KK, Bora A, Bora M. Nutritional evaluation of fodder, its preference and crop raiding by wild Asian elephant (Elephas maximus) in Sonitpur District of Assam, India. Vet World 2014. [DOI: 10.14202/vetworld.2014.1082-1089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shaw J, Young J, Butow P, Chambers S, O'Brien L, Solomon M. Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication. PATIENT EDUCATION AND COUNSELING 2013; 93:444-450. [PMID: 23910248 DOI: 10.1016/j.pec.2013.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 05/13/2013] [Accepted: 07/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training. METHODS 50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C. RESULTS Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice. CONCLUSIONS This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus. PRACTICE IMPLICATIONS Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.
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Affiliation(s)
- Joanne Shaw
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, Australia; University of Sydney, Australia.
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van-Velthoven MHMMT, Tudor Car L, Gentry S, Car J. Telephone delivered interventions for preventing HIV infection in HIV-negative persons. Cochrane Database Syst Rev 2013:CD009190. [PMID: 23728688 DOI: 10.1002/14651858.cd009190.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This is one of the three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Although HIV infection can be prevented, still a large number of new infections occur. More effective HIV prevention interventions are needed to reduce the number of people newly infected with HIV. Phone calls can be used to potentially more effectively deliver HIV prevention interventions. They have the potential to save time, reduce costs and facilitate easier access. OBJECTIVES To assess the effectiveness of voice landline and mobile telephone delivered HIV prevention interventions in HIV-negative persons. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, Web of Science, Cumulative Index to Nursing & Allied Health, the World Health Organization's Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International and the Centre for Agricultural Bioscience International Direct Global Health database, the System for Information on Grey Literature Europe, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections database, International AIDS Society conference database, AIDS Education Global Information System and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of delivering HIV prevention by phone calls to usual care in HIV-negative people regardless of their demographic characteristics and in all settings. DATA COLLECTION AND ANALYSIS Two reviewers independently searched databases, screened citations, assessed study quality and extracted data. A third reviewer resolved any disagreement. Primary outcomes were knowledge about the causes and consequences of HIV/AIDS, change in behaviour, healthcare uptake and clinical outcomes. Secondary outcomes were users' and providers' views on the intervention, economic outcomes and adverse outcomes. MAIN RESULTS Out of 14,717 citations, only one study met the inclusion criteria. The included RCT recruited women and girl children who received post-exposure prophylaxis (PEP) after rape from sexual assault services in South Africa between August 2007 and May 2008.Participants (n (number) =274) were randomised into a telephone support (n=136) and control (n=138) group. Control group participants received usual care (an interactive information session) from the sexual assault service during the 28 days in which they had to take PEP, with no further contact from the study staff. Telephone support group participants received standard care and phone calls from a counsellor throughout the 28 days when they had to take PEP.Overall, adherence to PEP was not significantly (P=0.13) different between the intervention (38.2%) and control (31.9 %) groups. Also, the proportion of participants who read a pamphlet, did not return to collect medication or with a depression were not significantly different between the intervention and control groups (P=0.006, P=0.42, P=0.72 respectively). The proportion of participants who used a diary was significantly (P=0.001) higher in the intervention group (78.8%) versus the control group (69.9%). The study authors reported that there were no recorded adverse events. The RCT did not provide information about participants' and providers' evaluation outcomes, or economic outcomes. The study had a moderate risk of bias. AUTHORS' CONCLUSIONS We found only one RCT, with a moderate risk of bias, which showed that providing PEP support by phone calls did not result in higher adherence to PEP. However, the RCT was conducted in an upper-middle-income country with high HIV prevalence, on a high-risk population and the applicability of its results on other settings and contexts is unclear. There is a need for robust evidence from various settings on the effectiveness of using phone calls for providing PEP support and for other HIV prevention interventions.
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Affiliation(s)
- Michelle H M M T van-Velthoven
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London,UK
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Gentry S, van‐Velthoven MHMMT, Tudor Car L, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database Syst Rev 2013; 2013:CD009189. [PMID: 23728687 PMCID: PMC6485935 DOI: 10.1002/14651858.cd009189.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This is one of three Cochrane reviews examining the role of the telephone in HIV/AIDS services. Telephone interventions, delivered either by landline or mobile phone, may be useful in the management of people living with HIV (PLHIV) in many situations. Telephone delivered interventions have the potential to reduce costs, save time and facilitate more support for PLHIV. OBJECTIVES To assess the effectiveness of voice landline and mobile telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed Central, EMBASE, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health, World Health Organisation's The Global Health Library and Current Controlled Trials from 1980 to June 2011. We searched the following grey literature sources: Dissertation Abstracts International, Centre for Agriculture Bioscience International Direct Global Health database, The System for Information on Grey Literature Europe, The Healthcare Management Information Consortium database, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society, AIDS Educational Global Information System and reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series studies comparing the effectiveness of telephone delivered interventions for reducing morbidity and mortality in persons with HIV infection versus in-person interventions or usual care, regardless of demographic characteristics and in all settings. Both mobile and landline telephone interventions were included, but mobile phone messaging interventions were excluded. DATA COLLECTION AND ANALYSIS Two reviewers independently searched, screened, assessed study quality and extracted data. Primary outcomes were change in behaviour, healthcare uptake or clinical outcomes. Secondary outcomes were appropriateness of the mode of communication, and whether underlying factors for change were altered. Meta-analyses, each of three studies, were performed for medication adherence and depressive symptoms. A narrative synthesis is presented for all other outcomes due to study heterogeneity. MAIN RESULTS Out of 14 717 citations, 11 RCTs met the inclusion criteria (1381 participants).Six studies addressed outcomes relating to medication adherence, and there was some evidence from two studies that telephone interventions can improve adherence. A meta-analysis of three studies for which there was sufficient data showed no significant benefit (SMD 0.49, 95% CI -1.12 to 2.11). There was some evidence from a study of young substance abusing HIV positive persons of the efficacy of telephone interventions for reducing risky sexual behaviour, while a trial of older persons found no benefit. Three RCTs addressed virologic outcomes, and there is very little evidence that telephone interventions improved virologic outcomes. Five RCTs addressed outcomes relating to depressive and psychiatric symptoms, and showed some evidence that telephone interventions can be of benefit. Three of these studies which focussed on depressive symptoms were combined in a meta-analysis, which showed no significant benefit (SMD 0.02, 95% CI -0.18 to 0.21 95% CI). AUTHORS' CONCLUSIONS Telephone voice interventions may have a role in improving medication adherence, reducing risky sexual behaviour, and reducing depressive and psychiatric symptoms, but current evidence is sparse, and further research is needed.
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Affiliation(s)
- Sarah Gentry
- Peninsula College of Medicine and DentistryExeterUK
| | - Michelle HMMT van‐Velthoven
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt. Dunstans RoadHammersmithLondonUKW6 8RP
| | | | - Josip Car
- Imperial College LondonGlobal eHealth Unit, Department of Primary Care and Public Health, School of Public HealthSt. Dunstans RoadHammersmithLondonUKW6 8RP
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Schaufelberger M, Harris M, Frey P. Emergency telephone consultations: a new course for medical students. CLINICAL TEACHER 2013; 9:373-5. [PMID: 23167879 DOI: 10.1111/j.1743-498x.2012.00590.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Using the telephone for consultations is now common practice. Although there is a clear need for specific training for telephone consultations, it is uncommon for it to be taught in medical school. METHODS A practical course on emergency telephone consultations (ECTs) was designed for the medical degree course at the University of Bern Medical School. During the module, each of the volunteer fifth-year medical students had to perform two simulated telephone consultations. Medical students in their first year of medical school acted as simulated patients (SPs), and they gave immediate feedback to the participants. RESULTS Nineteen per cent of fifth-year students voluntarily undertook the ETC course. The course was rated 'very informative' by 68 per cent of the participants, and 'informative' by 32 per cent. Ninety-four per cent of the attendees recorded a personal learning gain, and 68 per cent suggested that the course should be obligatory. All the participants thought that the SPs played their roles realistically. DISCUSSION In their rating of the ETC, the fifth-year students gave it a mean mark of 5.5 (out of a maximum of 6), suggesting that they thought it had been very successful. Students became aware of their need for ETC training through the course itself, and they recommended that it should be obligatory. The ETC pilot received a highly positive response from lead clinicians who anticipated a rising number of telephone consultations, and who have to deal with trainees who have not been taught about how to deal with ETCs. As a result, the Faculty of Medicine decided to make the course obligatory.
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Tudor Car L, Gentry S, van-Velthoven MHMMT, Car J. Telephone communication of HIV testing results for improving knowledge of HIV infection status. Cochrane Database Syst Rev 2013:CD009192. [PMID: 23440835 DOI: 10.1002/14651858.cd009192.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND This is one of three Cochrane reviews that examine the role of the telephone in HIV/AIDS services. Both in developed and developing countries there is a large proportion of people who do not know they are infected with HIV. Knowledge of one's own HIV serostatus is necessary to access HIV support, care and treatment and to prevent acquisition or further transmission of HIV. Using telephones instead of face-to-face or other means of HIV test results delivery could lead to more people receiving their HIV test results. OBJECTIVES To assess the effectiveness of telephone use for delivery of HIV test results and post-test counselling.To evaluate the effectiveness of delivering HIV test results by telephone, we were interested in whether they can increase the proportion of people who receive their HIV test results and the number of people knowing their HIV status. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed Central, PsycINFO, ISI Web of Science, Cumulative Index to Nursing & Allied Health (CINAHL), WHOs The Global Health Library and Current Controlled Trials from 1980 to June 2011. We also searched grey literature sources such as Dissertation Abstracts International,CAB Direct Global Health, OpenSIGLE, The Healthcare Management Information Consortium, Google Scholar, Conference on Retroviruses and Opportunistic Infections, International AIDS Society and AEGIS Education Global Information System, and reference lists of relevant studies for this review. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised controlled trials (qRCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) studies comparing the effectiveness of telephone HIV test results notification and post-test counselling to face-to-face or other ways of HIV test result delivery in people regardless of their demographic characteristics and in all settings. DATA COLLECTION AND ANALYSIS Two reviewers independently searched, screened, assessed study quality and extracted data. A third reviewer resolved any disagreement. MAIN RESULTS Out of 14 717 citations, only one study met the inclusion criteria; an RCT conducted on homeless and high-risk youth between September 1998 and October 1999 in Portland, United States. Participants (n=351) were offered counselling and oral HIV testing and were randomised into face-to-face (n=187 participants) and telephone (n=167) notification groups. The telephone notification group had the option of receiving HIV test results either by telephone or face-to-face. Overall, only 48% (n=168) of participants received their HIV test results and post-test counselling. Significantly more participants received their HIV test results in the telephone notification group compared to the face-to-face notification group; 58% (n=106) vs. 37% (n=62) (p < 0.001). In the telephone notification group, the majority of participants who received their HIV test results did so by telephone (88%, n=93). The study could not offer information about the effectiveness of telephone HIV test notification with HIV-positive participants because only two youth tested positive and both were assigned to the face-to-face notification group. The study had a high risk of bias. AUTHORS' CONCLUSIONS We found only one eligible study. Although this study showed the use of the telephone for HIV test results notification was more effective than face-to-face delivery, it had a high-risk of bias. The study was conducted about 13 years ago in a high-income country, on a high-risk population, with low HIV prevalence, and the applicability of its results to other settings and contexts is unclear. The study did not provide information about telephone HIV test results notification of HIV positive people since none of the intervention group participants were HIV positive. We found no information about the acceptability of the intervention to patients' and providers', its economic outcomes or potential adverse effects. There is a need for robust evidence from various settings on the effectiveness of telephone use for HIV test results notification.
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Röing M, Rosenqvist U, K. Holmström I. Threats to patient safety in telenursing as revealed in Swedish telenurses' reflections on their dialogues. Scand J Caring Sci 2013; 27:969-76. [DOI: 10.1111/scs.12016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/09/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Marta Röing
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
| | - Urban Rosenqvist
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
| | - Inger K. Holmström
- Department of Public Health and Caring Sciences; Health Services Research; Uppsala University; Uppsala Sweden
- School of Health and Medicine; Örebro University; Örebro Sweden
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Campbell JL, Britten N, Green C, Holt TA, Lattimer V, Richards SH, Richards DA, Salisbury C, Taylor RS, Fletcher E. The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: study protocol for a cluster randomised controlled trial comparing nurse-led and GP-led management systems (ESTEEM). Trials 2013; 14:4. [PMID: 23286331 PMCID: PMC3574027 DOI: 10.1186/1745-6215-14-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 12/13/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Recent years have seen an increase in primary care workload, especially following the introduction of a new General Medical Services contract in 2004. Telephone triage and telephone consultation with patients seeking health care represent initiatives aimed at improving access to care. Some evidence suggests that such approaches may be feasible but conclusions regarding GP workload, cost, and patients' experience of care, safety, and health status are equivocal. The ESTEEM trial aims to assess the clinical- and cost-effectiveness of nurse-led computer-supported telephone triage and GP-led telephone triage, compared to usual care, for patients requesting same-day consultations in general practice. METHODS/DESIGN ESTEEM is a pragmatic, multi-centre cluster randomised clinical trial with patients randomised at practice level to usual care, computer decision-supported nurse triage, or GP-led triage. Following triage of 350-550 patients per practice we anticipate estimating and comparing total primary care workload (volume and time), the economic cost to the NHS, and patient experience of care, safety, and health status in the 4-week period following the index same-day consultation request across the three trial conditions.We will recruit all patients seeking a non-emergency same-day appointment in primary care. Patients aged 12.0-15.9 years and temporary residents will be excluded from the study.The primary outcome is the number of healthcare contacts taking place in the 4-week period following (and including) the index same-day consultation request. A range of secondary outcomes will be examined including patient flow, primary care NHS resource use, patients' experience of care, safety, and health status.The estimated sample size required is 3,751 patients (11,253 total) in each of the three trial conditions, to detect a mean difference of 0.36 consultations per patient in the four week follow-up period between either intervention group and usual care 90% power, 5% alpha, and an estimated intracluster correlation coefficient ICC of 0.05. The primary analysis will be based on the intention-to-treat principle and take the form of a random effects regression analysis taking account of the hierarchical nature of the study design. Statistical models will allow for adjustment for practice level minimisation variables and patient-level baseline covariates shown to differ at baseline. TRIAL REGISTRATION Current Controlled Trials ISCRTN20687662.
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Affiliation(s)
- John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Nicky Britten
- Institute of Health Service Research, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Colin Green
- Institute of Health Service Research, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Tim A Holt
- Department of Primary Care, Health Sciences, University of Oxford, Oxford, OX1 2ET, UK
| | - Valerie Lattimer
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - David A Richards
- Mood Disorders Centre, College of Life and Environmental Sciences, University of Exeter, Exeter, EX4 4QG, UK
| | - Chris Salisbury
- Academic Unit of Primary Health Care, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, EX1 2LU, UK
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Huibers L, Keizer E, Giesen P, Grol R, Wensing M. Nurse telephone triage: good quality associated with appropriate decisions. Fam Pract 2012; 29:547-52. [PMID: 22327415 DOI: 10.1093/fampra/cms005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Triage at out-of-hours GP cooperatives (GPCs) is aimed at determining medical urgency and guiding decisions. Both medical knowledge and communication skills are required for this complex task. OBJECTIVE To explore the impact of quality of consultation and estimated urgency on the appropriateness of decisions. METHODS We performed a secondary analysis of telephone triage consultations by nurses at 29 Dutch GPCs. Consultations were taped and assessed by trained observers, using a validated instrument. Measures concerned quality of consultation, nurse-estimated urgency (four levels) and appropriateness of decisions (urgency, follow-up advice and timing). Bivariate analyses and logistic multilevel regression analyses were used to explore the impact of quality of consultation (controlling for urgency) on appropriateness of decisions. RESULTS The sample included 6739 telephone contacts, most of which (90%) were non-urgent. The majority of decisions were appropriate (91% for urgency, 96% for follow-up advice and 95% for timing). In bivariate analyses, appropriateness of decisions was positively related to higher quality of consultation. Estimated urgency was negatively associated with quality of consultation. Logistic multilevel analysis showed that higher quality of consultation was related to a more appropriate estimation of urgency [odds ratio (OR) = 1.82; 95% confidence interval (CI): 1.69-1.95], follow-up advice (OR = 2.69; 95% CI: 2.41-3.01) and timing of decisions (OR = 2.41; 95% CI: 2.20-2.63). CONCLUSIONS High quality of consultation has a positive, but small, impact on the appropriateness of decisions. Quality of consultation needs to be targeted in training and support of triage nurses, especially when it concerns highly urgent contacts.
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Affiliation(s)
- L Huibers
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Grewal RS, Kazeem A, Pappas Y, Car J, Majeed A. Training interventions for improving telephone consultation skills in clinicians. Cochrane Database Syst Rev 2012. [DOI: 10.1002/14651858.cd010034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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van Velthoven MHMMT, Car LT, Car J, Atun R. Telephone consultation for improving health of people living with or at risk of HIV: a systematic review. PLoS One 2012; 7:e36105. [PMID: 22615751 PMCID: PMC3355163 DOI: 10.1371/journal.pone.0036105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 03/30/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low cost, effective interventions are needed to deal with the major global burden of HIV/AIDS. Telephone consultation offers the potential to improve health of people living with HIV/AIDS cost-effectively and to reduce the burden on affected people and health systems. The aim of this systematic review was to assess the effectiveness of telephone consultation for HIV/AIDS care. METHODS We undertook a comprehensive search of peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed the quality of randomized controlled trials which compared telephone interventions with control groups for HIV/AIDS care. Telephone interventions were voice calls with landlines or mobile phones. We present a narrative overview of the results as the obtained trials were highly heterogeneous in design and therefore the data could not be pooled for statistical analysis. RESULTS The search yielded 3321 citations. Of these, nine studies involving 1162 participants met the inclusion criteria. The telephone was used for giving HIV test results (one trial) and for delivering behavioural interventions aimed at improving mental health (four trials), reducing sexual transmission risk (one trial), improving medication adherence (two trials) and smoking cessation (one trial). Limited effectiveness of the intervention was found in the trial giving HIV test results, in one trial supporting medication adherence and in one trial for smoking cessation by telephone. CONCLUSIONS We found some evidence of the benefits of interventions delivered by telephone for the health of people living with HIV or at risk of HIV. However, only limited conclusions can be drawn as we only found nine studies for five different interventions and they mainly took place in the United States. Nevertheless, given the high penetration of low-cost mobile phones in countries with high HIV endemicity, more evidence is needed on how telephone consultation can aid in the delivery of HIV prevention, treatment and care.
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Affiliation(s)
| | - Lorainne Tudor Car
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Rifat Atun
- Imperial College Business School, Imperial College London, London, United Kingdom
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Veteran satisfaction with RN voice-mail greeting. J Nurs Care Qual 2012; 27:325-32. [PMID: 22573208 DOI: 10.1097/ncq.0b013e31825961ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Voice-mail communication is often used to convey information between the registered nurse (RN) and the Veteran. Using a pretest-posttest design, this study examined whether implementation of a standardized voice-mail greeting had an impact on Veteran satisfaction and the number of messages left on the RN voice-mail. Veterans were more satisfied and there was a significant decrease in RN voice-mail messages post-implementation. This study highlights effects of the voice-mail greeting and has implications for other health care settings.
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Kazeem A, Car J, Pappas Y. Telephone consultations for the management of alcohol-related disorders. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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LaVela SL, Gering J, Schectman G, Weaver FM. Optimizing primary care telephone access and patient satisfaction. Eval Health Prof 2011; 35:77-86. [PMID: 21685222 DOI: 10.1177/0163278711411479] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Telephone medicine is often preferred by patients to meet primary care needs and may be associated with high patient satisfaction. This article presents findings about incoming patient calls to primary care for medically based reasons during office hours and reports factors independently associated with telephone encounter satisfaction, considering patient characteristics, call reasons, and staff responsiveness, for a national cohort of primary care users. Interviews were conducted with patients from 18 nationwide primary care clinics during the fall of 2009. Calling for an urgent medical issue was associated with dissatisfaction. Odds of call satisfaction were greater when patients thought staff was friendly (10×), call answer was timely (5×), and needed medical information was provided (7×). These findings can be used for interventions to optimize telephone access and patient satisfaction which is beneficial because satisfactory telephone encounters reduce primary care use and satisfied patients are more likely to be engaged in their health care.
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Affiliation(s)
- Sherri L LaVela
- Center for Management of Complex Chronic Care, Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
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