Intervention Review

Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home

  1. Patriek Mistiaen1,*,
  2. Else Poot2

Editorial Group: Cochrane Consumers and Communication Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 30 JUL 2003

DOI: 10.1002/14651858.CD004510.pub3


How to Cite

Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004510. DOI: 10.1002/14651858.CD004510.pub3.

Author Information

  1. 1

    NIVEL, Netherlands Institute for Healthcare Services Research, Utrecht, Netherlands

  2. 2

    Netherlands Centre for Excellence in Nursing (LEVV), Utrecht, Netherlands

*Patriek Mistiaen, NIVEL, Netherlands Institute for Healthcare Services Research, PO Box 1568, Utrecht, 3500 BN, Netherlands. p.mistiaen@nivel.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

It is known that many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. In recent years many projects have addressed discharge planning, with the aim of reducing problems after discharge. Telephone follow-up (TFU) is seen as a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early, giving reassurance and providing quality aftercare service. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, at present it is not clear whether TFU is also effective in reducing postdischarge problems.

Objectives

To assess the effects of follow-up telephone calls in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home.

Search methods

We searched the following databases from their start date to July 2003, without limits as to date of publication or language: the Cochrane Consumers and Communication Review Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), PubMed, EMBASE (OVID), BiomedCentral, CINAHL, ERIC (OVID), INVERT (Dutch nursing literature index), LILACS, Picarta (Dutch library system), PsycINFO/PsycLIT (OVID), the Combined Social and Science Citation Index Expanded (SCI-E), SOCIOFILE. We searched for ongoing research in the following databases: National Research Register (http://www.update-software.com/nrr/); Controlled Clinical Trials (http://www.controlled-trials.com/); and Clinical Trials (http://clinicaltrials.gov/). We searched the reference lists of included studies and contacted researchers active in this area.

Selection criteria

Randomised and quasi-randomised controlled trials of TFU initiated by a hospital-based health professional, for patients discharged home from an acute hospital setting. The intervention was delivered within the first month after discharge; outcomes were measured within 3 months after discharge, and either the TFU was the only intervention, or its effect could be analysed separately.

Data collection and analysis

Two review authors independently assessed studies for inclusion and for methodological quality. The methodological quality of included studies was assessed using the criteria from the Cochrane Effective Practice and Organisation of Care Review Group. The data-extraction form was based on the template developed by the Cochrane Consumers and Communication Review Group. Data was extracted by one review author and checked by a second author. For as far it was considered that there was enough clinical homogeneity with regard to patient groups and measured outcomes, statistical pooling was planned using a random effects model and standardised mean differences for continuous scales and relative risks for dichotomous data, and tests for statistical heterogeneity were performed.

Main results

We included 33 studies involving 5110 patients. Predominantly, the studies were of low methodological quality. TFU has been applied in many patient groups. There is a large variety in the ways the TFU was performed (the health professionals who undertook the TFU, frequency, structure, duration, etc.). Many different outcomes have been measured, but only a few were measured across more than one study. Effects are not constant across studies, nor within patient groups. Due to methodological and clinical diversity, quantitative pooling could only be performed for a few outcomes. Of the eight meta-analyses in this review, five showed considerable statistical heterogeneity. Overall, there was inconclusive evidence about the effects of TFU.

Authors' conclusions

The low methodological quality of the included studies means that results must be considered with caution. No adverse effects were reported. Nevertheless, although some studies find that the intervention had favourable effects for some outcomes, overall the studies show clinically-equivalent results between TFU and control groups. In summary, we cannot conclude that TFU is an effective intervention.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Telephone follow-up by a hospital-based health professional after hospital discharge

Many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. Telephone follow-up, initiated by hospital-based health professionals, is considered to be a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early and giving reassurance to patients after discharge. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, until now it was not clear whether telephone follow-up is also effective. Our systematic review identified 33 relevant studies, almost all of which were of low methodological quality (a major limitation of the review). We found that telephone follow-up has been applied in many patient groups. There is great variety in the ways the telephone follow-up has been performed. Many different outcomes have been measured. Some studies found effects in favour of the telephone follow-up intervention, but overall studies identified no statistically significant differences between the telephone follow-up and control groups. For as far as the results of studies could be pooled together, we could draw no firm conclusions about the effects of telephone follow-up. No studies identified adverse effects of the intervention.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

院內醫療專業人員主動電話追蹤出院後病人的居家照護問題

許多病人在出院後的第一個星期,在居家照護上會遭遇很多不同的問題。最近幾年,很多研究的目標是設定減少病人出院後的問題。電話追蹤(Telephone followup (TFU))是一種良好的互相溝通管道,可以提供健康知識以及衛教,同時掌握病人的病情以及早期發現是否有併發症,也可以讓病患安慰以及確保出院後的照護品質。有些研究發現電話追蹤是一種可行的辦法,而且病患都對電話追蹤持正面的評價。然而,目前還不清楚電話追蹤是否也可以減少出院後在居家照護的問題。

目標

評估院內醫護人員主動在病人出院後第一個月電話追蹤的效果

搜尋策略

我們搜尋了以下的資料庫,並且從資料庫開始的日期一直搜尋到2003年的7月:the Cochrane Consumers and Communication Review Group's Specialised Register、the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library) 、PubMed, EMBASE (OVID) 、BiomedCentral、CINAHL、ERIC (OVID) 同時也搜尋了INVERT (Dutch nursing literature index) 、LILACS、Picarta (Dutch library system) 、PsycINFO/PsycLIT (OVID) 、the Combined Social and Science Citation Index Expanded (SCIE) 以及SOCIOFILE。其中並沒有對出版日期或語言設限。我們也從以下的資料庫中,搜尋了目前正在進行中的研究計畫: 1. National Research Register (http://www.updatesoftware.com/nrr/); 2. Controlled Clinical Trials (http://www.controlledtrials.com/) 3. Clinical Trials (http://clinicaltrials.gov/) 我們搜尋了參考資料中的文獻,也聯絡了相關的研究人員。

選擇標準

醫療專業人員在病人從急性病房出院後,以電話追蹤方式設計的隨機以及半隨機對照臨床試驗(Randomised and quasirandomised controlled trials)。我們在病人出院後的第一個月,以電話追蹤的介入,並在出院後3個月評估研究的成果。研究成果是評估以電話追蹤為唯一的介入措施,或分別分析它的影響。

資料收集與分析

2位評論作家分別獨立的評估納入標準以及研究方法的品質,我們使用從Cochrane Effective Practice and Organisation of Care Review Group取得的標準來評估納入的研究方法的品質,數據資料的摘錄表是以Cochrane Consumers and Communication Review Group為範例。由1位評論作家摘錄數據資料,再由另1位評論作家做確認。目前考量到在實驗組以及測量的結果中,已有足夠的臨床同質性(homogeneity)下,綜合統計計劃以隨機效果模式(random effects model)及標準化均數差(standardised mean difference,SMD)分析連續數據(continuous scales),以相對風險(relative risks,RR)分析二元資料(dichotomous data)並執行統計異質性(statistical heterogeneity)測試。

主要結論

我們一共納入了33個研究,總共有5110位病人參與。很明顯的,這些研究的研究方法品質不是很好。有很多的病人組別都使用電話追蹤,但在進行電話追蹤的方法上變異很大(進行電話追蹤的專業醫療人員、電話的頻率、內容架構以及持續的時間等等)。雖然測量了許多種研究結果指標,但是僅有少數被運用在1個以上的研究。在不同研究與病患組別間的效果也不一致。基於研究方法以及臨床上的多樣性,只有少數的研究結果可以被彙整量化。本篇評論中的8個統合分析(metaanalyses)中,5個有顯著的統計異質性(heterogeneity;環境或生物族群之具有各種不同特性之素質)。整體上,電話追蹤的效果仍未有明確的證據。

作者結論

我們必須謹慎的解讀研究的成果,因為被納入的研究中,研究方法的品質並不好。在這些研究中,並沒有報告出不良反應,不過,雖然有些研究發現電話追蹤的介入是有利的,但是整體而言,這些研究發現在實驗組以及對照組中,臨床上的結果是一樣的。總之,我們無法下結論說電話追蹤是一個有效的介入方法。

翻譯人

本摘要由成功大學附設醫院蔡佩蓉翻譯。

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

總結

目前沒有證據證明出院後的電話追蹤是有效的,許多病人在出院後的第一個星期,在居家照護上會遭遇很多不同的問題。由院內醫療人員主動電話追蹤是一種良好的互相溝通管道,可以提供健康知識以及衛教,同時掌握病人的病情以及早期發現是否有併發症,也可以讓病患安慰以及確保出院後的照護品質。有些研究發現電話追蹤是一種可行的辦法,而且病患都對電話追蹤持正面的評價。然而,目前為止我們對電話追蹤的效果仍然不是很明確,我們的系統回顧確認了33個相關的臨床試驗,但是幾乎所有研究方法的品質都不好(回顧分析中重要的限制)。我們發現在很多病人組別中,都應用了電話追蹤的方法,而且是以很多不同的方式在執行電話追蹤。我們評估了許多不同的研究結果,其中有一些研究結果發現有利於電話追蹤的介入,但是整體來說,實驗組以及對照組的研究成果,在統計學上並沒有任何顯著的不同。目前為止的研究結果可能可以放在一起彙整分析,我們卻無法對電話追蹤效果做出一個強而有力的結論。尚未有研究確認此類介入有何不良反應。