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Vainio H, Soininen L, Castrén M, Torkki P. Identifying performance indicators to measure overall performance of telephone triage - a scoping review. Scand J Prim Health Care 2024; 42:38-50. [PMID: 38078730 PMCID: PMC10851803 DOI: 10.1080/02813432.2023.2283188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/08/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This article aims to summarize performance indicators used in telephone triage services research, and make recommendations for the selection of valid indicators to measure the performance of telephone triage. We describe what kind of frameworks, performance indicators, or variables have been used for evaluating telephone triage performance by systematically mapping the telephone triage performance measurement. The objective was to find measures for each Triple Aim dimension. DESIGN A scoping review method was used following Joanna Briggs Institute guidelines. Using this method, we defined indicators to measure the performance of telephone triage. We used the Triple Aim framework to identify indicators to measure the overall performance of telephone triage. The Triple Aim framework consists of improving the patient experience of care, improving the health of populations, and reducing cost per capita. SETTING The scoping review was performed using CINAHL, Medline, EBSCOhost, and PubMed electronic databases. The eligibility criterion was research published in English between 2015 and 2023. The inclusion focused on the use and performance of telephone triage services and system-focused studies. RESULTS A total of 1098 papers were screened for inclusion, with 57 papers included in our review. We identified 13 performance indicators covering all Triple Aim dimensions: waiting times, access, patient satisfaction, the accuracy of triage decision, severity and urgency of the symptoms, triage response, patient compliance with the advice given, follow-up healthcare service use, and running costs of service. We didn't find any earlier framework covering all Triple Aim dimensions properly. CONCLUSIONS Measuring the performance of telephone triage requires an extensive and comprehensive approach. We presented performance indicators that may be included in the framework for measuring the performance of telephone triage to support overall performance measurements of telephone triage.
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Affiliation(s)
- Hanna Vainio
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Leena Soininen
- DigiFinland Ltd., University of Helsinki, Helsinki, Finland
| | - Maaret Castrén
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Shi X, Wu Y, Yuan J, Wang X, Guo C, Zang S. Association between Body Image Flexibility and Intermittent Fasting in Chinese Medical Students: A Cross-Sectional Study. Nutrients 2023; 15:4273. [PMID: 37836557 PMCID: PMC10574058 DOI: 10.3390/nu15194273] [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: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Unhealthy dietary behaviors and body dissatisfaction are becoming increasingly common among college students. Understanding the association between body image flexibility and intermittent fasting is particularly meaningful, especially for medical college students. This study aimed to investigate the association between body image flexibility and intermittent fasting among medical students. We conducted a cross-sectional study with 5138 medical college students at Jitang College of North China University of Science and Technology. Univariate and multivariate logistic regression were used to evaluate the association between body image flexibility and intermittent fasting. Subgroup analysis and interaction tests were further used to examine the possible interaction between body image flexibility and intermittent fasting. In this study, 1329 (25.87%) students had intermittent fasting behavior. After adjustment for confounding factors, there was a negative association between body image flexibility and intermittent fasting (OR = 0.94, 95%CI = 0.93 to 0.95, p < 0.001). A significant interaction between body image flexibility and intermittent fasting was found in gender, academic year, major, and monthly living expenses (p for interaction < 0.05). E-value analysis suggested there was unlikely to be an unmeasured confounding. This association could contribute to the establishment of personalized health intervention strategies and provide recommendations for promoting the physical and mental health of medical students.
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Affiliation(s)
- Xinji Shi
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang 110122, China; (X.S.); (X.W.); (C.G.)
| | - Yibo Wu
- School of Public Health, Peking University, Beijing 100191, China;
| | - Jie Yuan
- Jitang College of North China University of Science and Technology, Tangshan 063000, China;
| | - Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang 110122, China; (X.S.); (X.W.); (C.G.)
| | - Chaowei Guo
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang 110122, China; (X.S.); (X.W.); (C.G.)
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang 110122, China; (X.S.); (X.W.); (C.G.)
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Brasseur E, Gilbert A, Donneau AF, Monseur J, Ghuysen A, D’Orio V. Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm. Acta Clin Belg 2022; 77:640-646. [PMID: 34081571 DOI: 10.1080/17843286.2021.1936353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. METHODS In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients' triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. RESULTS 10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. CONCLUSION SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.
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Affiliation(s)
- Edmond Brasseur
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
| | - Allison Gilbert
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
| | - Anne-Françoise Donneau
- Biostatistics Unit, University of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Justine Monseur
- Biostatistics Unit, University of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
- Public Health Department, University of Liège, Liège, Belgium
| | - Vincent D’Orio
- Emergency Department, University Hospital Center of Liège, Liège, Belgium
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Oncology Nursing Telephone Triage Workshop: Impact on Nurses' Knowledge, Confidence, and Skill. Cancer Nurs 2021; 45:E463-E470. [PMID: 34483280 DOI: 10.1097/ncc.0000000000000978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outpatient oncology nurses are responsible for symptom assessment/management and care coordination during telephone triage. Nursing telephone triage interventions can improve patient outcomes and clinical efficiency. Therefore, the lack of education and training in telephone triage can greatly impact patient care. OBJECTIVE Using a prospective pretest/posttest design, we sought to determine if a telephone triage educational workshop would improve oncology nurses' knowledge, confidence, and skill over 12 weeks. INTERVENTION/METHODS The educational intervention incorporated an online didactic lecture, group case scenario, and feedback on a virtual triage simulation. Evaluation was conducted before and after the intervention through an online, 13-item survey (knowledge and confidence) and simulation utilizing a 56-item checklist (skills). RESULTS Thirteen oncology nurses were enrolled; 54% did not have telephone triage experience before this job. A total of 12 participants completed the workshop. From pretest to posttest, there was a median 1.0 out of 5.0 (interquartile range, 2.8) improvement in confidence (P = .008) and a 26.3% (interquartile range, 15.2) improvement in skills (P = .002). There was no difference in knowledge scores from pretest to posttest (P = .11). CONCLUSIONS This workshop was associated with an improvement in oncology nurse confidence and skill, using telephone triage models. It benefits an existing process within the outpatient center and it highlights a new educational strategy that may optimize nursing practice and improve patient care and experience. IMPLICATIONS FOR PRACTICE This workshop contributes to existing evidence of telephone triage models and nursing education. The findings can guide future research, nursing orientation, and educational activities within the field of nursing and telehealth.
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Åvik Persson H, Ahlström G, Ekwall A. Professionals' Expectations and Preparedness to Implement Knowledge-Based Palliative Care at Nursing Homes before an Educational Intervention: A Focus Group Interview Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178977. [PMID: 34501567 PMCID: PMC8431503 DOI: 10.3390/ijerph18178977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
The provision of knowledge-based palliative care is rare in nursing homes. There are obstacles to practically performing this because it can be difficult to identify when the final stage of life begins for older persons. Educational interventions in palliative care in nursing homes are a challenge, and joint efforts are needed in an organisation, including preparedness. The aim was to explore professionals' expectations and preparedness to implement knowledge-based palliative care in nursing homes before an educational intervention. This study has a qualitative focus group design, and a total of 48 professionals working in nursing homes were interviewed with a semi-structured interview guide. Qualitative content analysis with an inductive approach was used for the analysis. One major theme was identified: professionals were hopeful yet doubtful about the organisation's readiness. The main categories of increased knowledge, consensus in the team, and a vision for the future illustrate the hopefulness, while insufficient resources and prioritisation illustrate the doubts about the organisation's readiness. This study contributes valuable knowledge about professionals' expectations and preparedness, which are essential for researchers to consider in the planning phase of an implementation study. The successful implementation of changes needs to involve strategies that circumvent the identified obstacles to organisations' readiness.
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Lindberg BH, Rebnord IK, Høye S. Phone triage nurses' assessment of respiratory tract infections - the tightrope walk between gatekeeping and service providing. A qualitative study. Scand J Prim Health Care 2021; 39:139-147. [PMID: 33792485 PMCID: PMC8293966 DOI: 10.1080/02813432.2021.1908715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Phone nurses triage callers to Norwegian out-of-hours cooperatives to estimate the appropriate urgency and level of care for the caller. Many callers with mild symptoms of respiratory tract infections receive a doctor's consultation, which may lead to busy sessions and in turn impair clinical decisions. OBJECTIVE This study explores how phone triage nurses assess callers with mild-to-moderate symptoms of respiratory tract infections and their views and experiences on triaging and counselling these callers. METHODS We conducted four focus groups with 22 nurses (five men and 17 women aged 24-66 years) in three different locations in Norway. The interviews were transcribed verbatim and analysed by systematic text condensation. RESULTS The informants were reluctant to call themselves gatekeepers. However, their description of their work indicates that they practice such a role. When nurses and callers disagreed about the right level of care, the informants sought consensus through strategies and negotiations. The informants described external factors such as organisational or financial issues as decisive for the population's use of out-of-hours services. They also described callers' characteristics, such as language deficiency and poor ability to describe symptoms, as determining their own clinical assessments. CONCLUSIONS Nurses perceive assessments of callers with respiratory tract infections as challenging. They need skills and time to reach a consensus with the callers and guide them to the right level of health care. This should be considered when planning nurse training and staffing of out-of-hours cooperatives.KEY-POINTSPhone triage nurses assess callers to the out-of-hours service and estimate the level of urgencyThis study explores how phone triage nurses assess callers with respiratory tract infections and their views and experiences on this taskThe nurses describe their professional role as a tightrope walk between gatekeeping and service providingThe nurses seek consensus with callers through strategies and negotiations.
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Affiliation(s)
- Bent Håkan Lindberg
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Islam F, Sabbe M, Heeren P, Milisen K. Consistency of decision support software-integrated telephone triage and associated factors: a systematic review. BMC Med Inform Decis Mak 2021; 21:107. [PMID: 33743697 PMCID: PMC7981379 DOI: 10.1186/s12911-021-01472-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background In the recent decades, the use of computerized decision support software (CDSS)-integrated telephone triage (TT) has become an important tool for managing rising healthcare demands and overcrowding in the emergency department. Though these services have generally been shown to be effective, large gaps in the literature exist with regards to the overall quality of these systems. In the current systematic review, we aim to document the consistency of decisions that are generated in CDSS-integrated TT. Furthermore, we also seek to map those factors in the literature that have been identified to have an impact on the consistency of generated triage decisions. Methods As part of the TRANS-SENIOR international training and research network, a systematic review of the literature was conducted in November 2019. PubMed, Web of Science, CENTRAL, and the CINAHL database were searched. Quantitative articles including a CDSS component and addressing consistency of triage decisions and/or factors associated with triage decisions were eligible for inclusion in the current review. Studies exploring the use of other types of digital support systems for triage (i.e. web chat, video conferencing) were excluded. Quality appraisal of included studies were performed independently by two authors using the Methodological Index for Non-Randomized Studies. Results From a total of 1551 records that were identified, 39 full-texts were assessed for eligibility and seven studies were included in the review. All of the studies (n = 7) identified as part of our search were observational and were based on nurse-led telephone triage. Scientific efforts investigating our first aim was very limited. In total, two articles were found to investigate the consistency of decisions that are generated in CDSS-integrated TT. Research efforts were targeted largely towards the second aim of our study—all of the included articles reported factors related to the operator- (n = 6), patient- (n = 1), and/or CDSS-integrated (n = 2) characteristics to have an influence on the consistency of CDSS-integrated TT decisions. Conclusion To date, some efforts have been made to better understand how the use of CDSS-integrated TT systems may vary across settings. In general, however, the evidence-base surrounding this field of literature is largely inconclusive. Further evaluations must be prompted to better understand this area of research. Protocol registration The protocol for this study is registered in the PROSPERO database (registration number: CRD42020146323). Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01472-3.
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Affiliation(s)
- Farah Islam
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.,Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pieter Heeren
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium. .,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Rysst Gustafsson S, Eriksson I. Quality indicators in telephone nursing - An integrative review. Nurs Open 2020; 8:1301-1313. [PMID: 33369230 PMCID: PMC8046143 DOI: 10.1002/nop2.747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to identify factors that indicate quality in telephone nursing. Design An integrative literature review. Method A literature search was performed in October 2018, in the PubMed, CINAHL, Cochrane Library, Academic Search, PsycINFO, Scopus and Web of Science databases. A total of 30 included were included and data that corresponded to the study's aim were extracted and categorized along the three areas of quality as described by Donabedian (Milbank Quarterly, 83, 691), namely structure, process and outcome. Results The analysis revealed ten factors indicating quality in telephone nursing (TN): availability and simplicity of the service, sustainable working conditions, specialist education and TN experience, healthcare resources and organization, good communication, person‐centredness, competence, correct and safe care, efficiency and satisfaction. TN services need to target all ten factors to ensure that the care given is of high quality and able to meet today's requirements for the service.
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Affiliation(s)
- Silje Rysst Gustafsson
- Division of nursing and medical technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Irene Eriksson
- School of Health Sciences, University of Skövde, Skövde, Sweden
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Sepulveda-Pacsi AL. Emergency Nurses’ Perceived Confidence in Participating in the Discharge Process of Congestive Heart Failure Patients From the Emergency Department: A Quantitative Study. HISPANIC HEALTH CARE INTERNATIONAL 2019; 17:30-35. [DOI: 10.1177/1540415318818983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Adults with exacerbated heart failure (HF) who present to the emergency department (ED) generally are readmitted. However, Hispanic HF patients are more likely to be admitted than Whites. Studies show the importance of nurse-led interventions in the ED discharge process, but registered nurse (RN) confidence in performing discharge tasks has not been assessed. Greater nurse confidence leads to improved task performance, and potentially reduced HF readmission, lowering cost of care. This study aimed to gain insight into ED RNs’ perceived self-confidence in discharge tasks with stabilized HF patients. Method: A self-report survey on perceived self-confidence was analyzed in a prospective, cross-sectional quantitative study. Participants were 22 RNs at an ED in a largely Hispanic community in New York City. Results: Moderate levels of confidence were found for performing various tasks with HF patients. Only 6 of the 21 nurses reported feeling “very confident” about discharge tasks. Twenty (90.1%) believed guidelines would increase their confidence. Conclusion: These findings can help in developing nurse-driven strategies to foster confidence in the discharge of stabilized HF patients from the ED.
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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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Payne L, Justice L, Lemle S, Elmaraghy CA, Ruda J, Jatana KR. Interventions to Improve Response Time to Nurse Triage Phone Calls in a Tertiary Care Pediatric Otolaryngology Practice. JAMA Otolaryngol Head Neck Surg 2018; 144:507-512. [DOI: 10.1001/jamaoto.2018.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Linda Payne
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Leslie Justice
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Stephanie Lemle
- Quality Improvement Services, Nationwide Children’s Hospital, Columbus, Ohio
| | - Charles A. Elmaraghy
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
- Wexner Medical Center, The Ohio State University, Columbus
| | - James Ruda
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
- Wexner Medical Center, The Ohio State University, Columbus
| | - Kris R. Jatana
- Department of Pediatric Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
- Wexner Medical Center, The Ohio State University, Columbus
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Martinsson J, Gustafsson S. Modeling the effects of telephone nursing on healthcare utilization. Int J Med Inform 2018; 113:98-105. [DOI: 10.1016/j.ijmedinf.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/23/2018] [Accepted: 02/03/2018] [Indexed: 11/26/2022]
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Paddison CAM, Abel GA, Burt J, Campbell JL, Elliott MN, Lattimer V, Roland M. What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey. BMJ Open 2018; 8:e018690. [PMID: 29431131 PMCID: PMC5829817 DOI: 10.1136/bmjopen-2017-018690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/30/2017] [Accepted: 12/19/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse). DESIGN Secondary analysis of data from the 2013 to 2014 General Practice Patient Survey. SETTING AND PARTICIPANTS 870 085 patients from 8005 English general practices. OUTCOMES Patient ratings of communication and 'trust and confidence' with the clinician they saw. RESULTS 77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients' choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was -15.8 points (95% CI -17.6 to -14.0) for confidence and trust in the practitioner and -10.5 points (95% CI -11.7 to -9.3) for net communication score, both on a 0-100 scale. CONCLUSIONS Patients' evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.
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Affiliation(s)
| | - Gary A Abel
- University of Exeter Medical School, Exeter, UK
| | - Jenni Burt
- Cambridge Centre for Health Services Research, Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Valerie Lattimer
- School of Health Sciences, Norwich Research Park, University of East Anglia, Norwich, UK
| | - Martin Roland
- Cambridge Centre for Health Services Research, Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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