Telephone consultation and triage: effects on health care use and patient satisfaction

 

Abstract

Background

Telephone consultation is the process where calls are received, assessed and managed by giving advice or by referral to a more appropriate service. In recent years there has been a growth in telephone consultation developed, in part, as a response to increased demand for general practitioner (GP) and accident and emergency (A&E) department care.

Objectives

To assess the effects of telephone consultation on safety, service usage and patient satisfaction and to compare telephone consultation by different health care professionals.

Search methods

We searched the Cochrane Central Register of Controlled Trials, the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register. We checked reference lists of identified studies and review articles and contacted experts in the field. The search was not restricted by language or publication status. The searches were updated in 2007 and no new studies were found.

Selection criteria

Randomised controlled trials (RCTs), controlled studies, controlled before/after studies (CBAs) and interrupted time series (ITSs) of telephone consultation or triage in a general health care setting. Disease specific phone lines were excluded.

Data collection and analysis

Two review authors independently screened studies for inclusion in the review, extracted data and assessed study quality. Data were collected on adverse events, service usage, cost and patient satisfaction. Due to heterogeneity we did not pool studies in a meta-analysis and instead present a narrative summary of the findings.

Main results

Nine studies met our inclusion criteria, five RCTs, one CCT and three ITSs. Six studies compared telephone consultation versus normal care; four by a doctor, one by a nurse and one by a clinic clerk. Three studies compared telephone consultation by different types of health care workers; two compared nurses with doctors and one compared health assistants with doctors or nurses. Three of five studies found a decrease in visits to GP's but two found a significant increase in return consultations. In general at least 50% of calls were handled by telephone advice alone. Seven studies looked at accident and emergency department visits, six showed no difference between the groups and one, of nurse telephone consultation, found an increase in visits. Two studies reported deaths and found no difference between nurse telephone triage and normal care.

Authors' conclusions

Telephone consultation appears to reduce the number of surgery contacts and out-of-hours visits by general practitioners. However, questions remain about its affect on service use and further rigorous evaluation is needed with emphasis on service use, safety, cost and patient satisfaction.

 

Plain language summary

Telephone consultation and triage: effects on health care use and patient satisfaction

Visits to emergency departments and family doctors have increased. One possible way to decrease the demands is to provide telephone helplines, hotlines or consultations. People can speak with health care professionals, such as doctors and nurses, on the telephone and receive medical advice or a referral to an appropriate health service. Nine studies were found and analysed to determine whether telephone consultation was safe and effective. In general, at least half of the calls were handled by telephone only (without the need for face-to-face visits). It was found that telephone consultation appears to decrease the number of immediate visits to doctors and does not appear to increase visits to emergency departments. It is still unclear though, whether it is just delaying visits to a later time. Telephone consultation also appears to be safe and people were just as satisfied using the telephone as going to see someone face-to-face. There are still questions about its effectiveness and more research into the use, cost, safety and satisfaction of telephone consultation is needed.

 

摘要

背景

電話醫療諮詢與檢傷分類：對於健康照護利用與病患滿意度的影響

電話諮詢是接電話，評估並管理給予建議的過程或轉介到較適合的服務。最近這幾年電話諮詢的發展逐漸成長，一部分是為了回應一般科醫師與意外急救部門照護的需求增加。

目標

評估電話諮詢對於安全性，服務利用與病患滿意度的效果，並比較不同健康照護專家的電話諮詢。

搜尋策略

我們檢索 the Cochrane Central Register of Controlled Trials，the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group，Pubmed，EMBASE，CINAHL，SIGLE，及the National Research Register。我們檢閱已確定研究及回顧文章的參考文獻，並連絡該領域的專家。檢索條件不限制語言或發表狀態。

選擇標準

一般健康照護機構中電話諮詢或檢傷分類的隨機對照試驗(Randomised controlled trials (RCTs))，對照研究，前後對照研究(controlled before/after studies (CBAs))及間斷時間序列(interrupted time series (ITSs))。排除特定疾病的電話線。

資料收集與分析

兩名回顧者分別檢閱研究以納入回顧中，並摘錄資料與評估研究品質。蒐集有關副作用，服務利用，成本與病患滿意度的資料。由於異質性，我們並未整合研究於統合分析中，並以描述性的統整結果取代之。

主要結論

九篇研究符合我們的納入標準，五篇為RCTs，一篇為CCT，而三篇為ITSs。六篇研究是比較電話諮詢與一般照護；其中四篇由醫師提供諮詢，一篇由護士而一篇由診所工作人員提供諮詢。三篇研究比較由不同類型的健康照護工作者提供電話諮詢；其中兩篇比較護士與醫師，而一篇比較健康助理與醫師或護士。五篇研究中有三篇發現GP的就診次數減少，但有兩篇發現回電諮詢的次數顯著增加。一般來說至少50%的來電可以只經由電話諮詢獲得解決。七篇研究觀察意外與急救部門的就診次數，六篇顯示組別之間沒有差異，而一篇由護士提供電話諮詢的研究發現就診次數有增加。兩篇研究發現由護士提供電話檢傷分類與一般照護之間其死亡結果沒有差異。

作者結論

電話諮詢顯示可以減少手術與日常時間外一般科醫師的就診次數。然而，它對服務的效果仍存在著問題且需要進一步嚴謹的評估服務利用，安全性，成本與病患滿意度。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

急診部門與家庭醫師的就診次數增加。一種可能減少需求的方式就是提供電話求助專線，熱線或諮詢。民眾可以在線上與健康照護專家對話，如醫師與護士，並接受醫療諮詢或轉介到適合的健康服務。發現九篇研究並分析以確定是否電話諮詢是安全並有效的。一般來說，至少有一半的來電可以只經由電話諮詢就獲得解決(不需要面對面就診)。發現電話諮詢可以減少醫師的就診次數且不會增加急診部門的就診。但仍然不清楚是否這只是因為延後就診的時間。電話諮詢也顯示是安全的且民眾使用電話諮詢的滿意度如同面對面就醫一樣。目前仍然存在著它的效果的問題，且需要更多有關電話諮詢對於醫療利用，成本，安全性與滿意度的研究。