Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home
Editorial Group: Cochrane Consumers and Communication Group
Published Online: 18 OCT 2006
Assessed as up-to-date: 30 JUL 2003
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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.
- Publication Status: Edited (no change to conclusions)
- Published Online: 18 OCT 2006
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.
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.
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.
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.
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.
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
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.
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 followup (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。
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 (SCIE) 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.updatesoftware.com/nrr/); 2. Controlled Clinical Trials (http://www.controlledtrials.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。
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 quasirandomised 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。
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。
此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。