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Mattisson M, Börjeson S, Årestedt K, Lindberg M. Interaction between telenurses and callers - A deductive analysis of content and timing in telephone nursing calls. PATIENT EDUCATION AND COUNSELING 2024; 123:108178. [PMID: 38387390 DOI: 10.1016/j.pec.2024.108178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/15/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To explore the content and timing of verbal interaction between telephone nurses and callers, and to suggest areas for improvement. METHODS Transcribed telephone conversations (n = 30) to a national nurse-led advisory service were analyzed using deductive content analysis. Categorization of data was based on components of interaction in the Interaction Model of Client Heath Behavior (IMCHB): health information, affective support, decisional control, and professional-technical competencies. The content was described both quantitatively, based on word count, and qualitatively, using descriptions and exemplars. Transcripts were also coded according to five phases in the conversation process: opening, listening, analyzing, motivating, and ending. The distribution of interaction components among phases was explored. RESULTS Interaction primarily focused on health information, particularly during the listening and analyzing phases. Telenurses based their advice on medical facts and guided callers through the conversation process. Callers' emotions and reflections on advice were rarely discussed. CONCLUSIONS Health information dominate conversations. Interaction can be further developed, particularly with respect to acknowledging callers' emotional responses, their reactions to advice, and ensuring clarity in exchange of health information. PRACTICE IMPLICATIONS Findings offer valuable guidance for future development of interaction in telenursing.
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Affiliation(s)
- Marie Mattisson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.
| | - Sussanne Börjeson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Department of Research, Region Kalmar County, Kalmar, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden, Region Kalmar County, Kalmar, Sweden
| | - Malou Lindberg
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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Duncan R, Stewart K, Scheuermeyer FX, Abu-Laban RB, Ho K, Lavallee D, Christenson J, Wood N, Bryan S, Hedden L. Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service. BMC Health Serv Res 2023; 23:1031. [PMID: 37759257 PMCID: PMC10523598 DOI: 10.1186/s12913-023-09821-w] [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: 03/24/2023] [Accepted: 07/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND British Columbia 8-1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers' subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. METHODS We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan-Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. RESULTS We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68-0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46-0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01-1.62]) or within 7 days (1.23 [95%CI: 1.11-1.37]), were more likely to do so than urban callers. INTERPRETATION Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to "Go to ED" is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.
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Affiliation(s)
- Ross Duncan
- Michael Smith Health Research British Columbia, Vancouver, Canada.
- BC Emergency Medicine Network, Vancouver, Canada.
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Kurtis Stewart
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Frank X Scheuermeyer
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Riyad B Abu-Laban
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kendall Ho
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Danielle Lavallee
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jim Christenson
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nancy Wood
- BC Emergency Medicine Network, Vancouver, Canada
| | - Stirling Bryan
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay Hedden
- Michael Smith Health Research British Columbia, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Mattisson M, Börjeson S, Lindberg M, Årestedt K. Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale. Scand J Caring Sci 2023; 37:687-697. [PMID: 36718016 DOI: 10.1111/scs.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
AIMS AND OBJECTIVES Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability. METHODOLOGICAL DESIGN AND JUSTIFICATION This psychometric study was based on cross-sectional data. RESEARCH METHODS, INSTRUMENTS, AND/OR INTERVENTIONS Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Cox's Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test-retest reliability with intraclass correlations. RESULTS The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88-0.96). Internal consistency (ordinal alpha = 0.82-0.97), scale reliability (0.88-0.99), and test-retest reliability (ICC = 0.77-0.86) were satisfactory for all scales. STUDY LIMITATIONS The study design did not allow drop-out analysis. CONCLUSIONS The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.
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Affiliation(s)
- Marie Mattisson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Sussanne Börjeson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Malou Lindberg
- 1177 Medical Advisory Service and Department of Health, Medicine and Caring services (HMV), Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
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Ho K, Abu-Laban RB, Stewart K, Duncan R, Scheuermeyer FX, Hedden L, Lauscher HN, Sundhu S, Chadha R, Christenson J, Grafstein E, Lavallee DC, Purssell R, Tallon JM, Wood N, Bryan S. Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study. CMAJ Open 2023; 11:E459-E465. [PMID: 37220956 DOI: 10.9778/cmajo.20220196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. METHODS We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. RESULTS We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. INTERPRETATION This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits.
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Affiliation(s)
- Kendall Ho
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Riyad B Abu-Laban
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Kurtis Stewart
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Ross Duncan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Frank X Scheuermeyer
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Lindsay Hedden
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Helen Novak Lauscher
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Sandra Sundhu
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Rina Chadha
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Jim Christenson
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Danielle C Lavallee
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Roy Purssell
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - John M Tallon
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Nancy Wood
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
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Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up? CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020179. [PMID: 36832308 PMCID: PMC9954649 DOI: 10.3390/children10020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children's characteristics and (3) to assess parents' reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child's age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child's condition (50.7%), parents' decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence.
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Rebolho RC, Raupp FM. Implementation costs of telephone nurse triage service. CAD SAUDE PUBLICA 2023; 39:e00095522. [PMID: 37075414 DOI: 10.1590/0102-311xen095522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/25/2023] [Indexed: 04/21/2023] Open
Abstract
Telephone nurse triage services are becoming increasingly common in healthcare systems worldwide. Florianópolis (Santa Catarina State, Brazil) is the first municipality in the country to provide this service in its public health system. This study adopted a quantitative, descriptive, and analytical methodology to evaluate the impact of this program on overall costs of the public health system. The research examined all 33,869 calls received by the telephone triage service from March 16 to October 31 in 2020, and calculated the program costs during the period. Avoided cost were calculated by the difference between estimated consultation costs considering patient-stated first alternative and the program recommendation after triage. Analyzing only the costs for the municipality of Florianópolis, the program's costs exceeded avoided costs by almost BRL 2.5 million during the period. By expanding the analysis to include costs of emergency department consultation - not administered by the municipality - based on data from previous research, we found that the program spares BRL 34.59 per call, a 21% cost reduction for the health system. Considering the preliminary results of the study and its limitations, it is understood that the service of telephone nurse triage can reduce costs in the healthcare system.
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Mattisson M, Börjeson S, Årestedt K, Lindberg M. Role of interaction for caller satisfaction in telenursing-A cross-sectional survey study. J Clin Nurs 2022. [PMID: 36081322 DOI: 10.1111/jocn.16524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/17/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore caller satisfaction with interaction, and the association to overall satisfaction with calls. BACKGROUND In the era of expanding healthcare at distance, the telephone remains a common tool for the provision of nursing care. Interaction between telenurse and caller in telenursing is vital for safety, satisfaction and adherence reasons. Few studies have quantitatively explored interaction in calls and how it relates to overall satisfaction with calls. DESIGN Cross-sectional survey study with a deductive approach. METHODS A total of 466 callers to the Swedish Medical Advisory Service completed the Telenursing Interaction and Satisfaction Questionnaire. Satisfaction with four theoretically defined components of interaction were compared using repeated measures ANOVA. Associations between satisfaction with interaction and overall satisfaction with calls were evaluated with ordinal logistic regression models with and without adjustment for age, sex, health status, waiting time, time for call, main result of the call and expectations. The study followed the STROBE checklist. RESULTS Callers were most satisfied with affective support, followed by professional-technical competence, health information and decisional control-in that order. A summated score of satisfaction with interaction was positively and significantly associated with overall satisfaction with calls before and after adjustment for waiting time, main result of call and variables related to the individual caller. CONCLUSIONS Caller satisfaction with interaction is generally high but can be improved, especially regarding decisional control. Satisfaction with interaction is important for overall satisfaction with calls. RELEVANCE TO CLINICAL PRACTICE This study provides support for professionals at all levels in telenursing organisations to pay attention to interactional matters. The development of best practice for telenurses needs to consider all four components of interaction to enhance satisfaction with calls.
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Affiliation(s)
- Marie Mattisson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Sussanne Börjeson
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Kalmar, Sweden
| | - Malou Lindberg
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden.,1177 Medical Advisory Service, Region Östergötland, Linköping, Sweden
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Jansen T, Hek K, Schellevis FG, Kunst AE, Verheij RA. Income-related differences in out-of-hours primary care telephone triage using national registration data. Emerg Med J 2021; 38:460-466. [PMID: 33853937 DOI: 10.1136/emermed-2020-209649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Telephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient's ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient's presented symptoms, assessed urgency and allocation of follow-up care in OPCS. METHOD Data were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients' income (standardised for household size as socioeconomic status (SES) indicator). RESULTS The most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS. CONCLUSIONS SES differences in the patient's presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.
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Affiliation(s)
- Tessa Jansen
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - François G Schellevis
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie VUMC, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, locatie AMC, Amsterdam, The Netherlands
| | - Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Tranzo, Tilburg University, School of Social and Behavioral Sciences, Tilburg, The Netherlands
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Wylie C, Harris K, Messina G, Dean D, Isoardi K. Documentation in the patient medical record was associated with improved adherence to Poisons Information Centres telephone advice. Clin Toxicol (Phila) 2020; 58:1058-1062. [PMID: 32141792 DOI: 10.1080/15563650.2020.1728297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Context: There is little research examining clinician adherence to specialist toxicological phone advice. Efforts to improve adherence should be sought to optimise the management of poisoned patients. This study aimed to determine if contemporaneous documentation in the patient electronic medical record (EMR) improved adherence to Poisons Information Centre (PIC) advice.Methods: This was a prospective before and after observational study following the implementation of documented poisoning management advice by PIC staff into the patient's EMR. Advice adherence was assessed following a review of the patient medical records and designated to complete adherence, minor discrepancies not affecting patient care, major discrepancies affecting patient care and non-adherence. The primary outcome was the proportion of satisfactory (complete adherence/minor discrepancies) adherence. Secondary outcomes included the accuracy of documented telephone advice by the treating clinician, the number of case recalls and episodes of sub-optimal management.Results: A total of 980 cases (347 in the pre-intervention phase and 633 in the post-intervention phase) were included in the study, of which 350 had PIC EMR documentation performed. Documented call advice by the treating clinician was absent in 41 of 347 cases (11.8%) cases and inaccurate in 42 of 306 cases (13.7%). Following PIC documentation, satisfactory adherence improved from 304/347(87.6%) to 333/350(95.1%)(difference 7.5% [95% CI 3.1% to 11.9%]), with suboptimal management decreasing from 48/347(13.8%) to 14/350(4%)(difference - 9.8% [95% CI -5.5% to -14.4%]). Recalls were similar in both periods. The median time to enter advice into the EMR was 26 min (IQR: 14-45 min). The main reason for not documenting advice was that the PIC staff member was working a solo shift with a prohibitively heavy workload.Discussion: EMRs enable PICs to supplement verbal advice with written documentation, offering an opportunity to improve communication and enable better handover of clinical information.Conclusion: Documentation of advice by PIC staff in the patient medical record was associated with improved advice adherence and reduced sub-optimal management.
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Affiliation(s)
- Carol Wylie
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia
| | - Keith Harris
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia.,Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Genevieve Messina
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia
| | - Danielle Dean
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia
| | - Katherine Isoardi
- Queensland Poisons Information Centre, Queensland Children's Hospital, South Brisbane, Australia.,Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Australia
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Siddiqui N, Greenfield D, Lawler A. Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service. Int J Health Plann Manage 2019; 35:735-745. [PMID: 31803956 DOI: 10.1002/hpm.2934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/24/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - Anthony Lawler
- Department of Health Tasmania, University of Tasmania, Hobart, Australia
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11
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Graf von Stillfried D, Czihal T, Meer A. Sachstandsbericht: Strukturierte medizinische Ersteinschätzung in Deutschland (SmED). Notf Rett Med 2019. [DOI: 10.1007/s10049-019-0627-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zusammenfassung
Ab 01.01.2020 müssen die Kassenärztlichen Vereinigungen eine telefonische Ersteinschätzung im 24/7-Betrieb anbieten. Ziel ist die Ersteinschätzung der Dringlichkeit akuter Beschwerden und eine Vermittlung an die angemessene Versorgungsstufe. Sehr schwer kranke Patienten müssen unmittelbar der Notfallversorgung, weniger oder nicht dringliche Anliegen alternativen Versorgungsangeboten zugeführt werden. Diese anspruchsvolle Aufgabe werden Fachpersonen übernehmen, die durch geeignete Software unterstützt werden. Im Ausland existieren hierfür Vorbilder. Das Zentralinstitut für die kassenärztliche Versorgung (Zi) überträgt gemeinsam mit der Health Care Quality System GmbH (HCQS) das in Teilen der Schweiz bereits angewendete Swiss Medical Assessment System (SMASS) für eine Anwendung in Deutschland. Das System soll unter dem Namen Strukturierte medizinische Ersteinschätzung in Deutschland (SmED) im Jahr 2019 in den Arztrufzentralen unter der Nummer 116117 eingeführt werden. Auch eine Anwendung für den sogenannten „gemeinsamen Tresen“ von Bereitschaftsdienstpraxen und Krankenhausnotaufnahmen wird entwickelt. Beide Anwendungen werden in dem vom Innovationsfonds geförderten DEMAND-Projekt evaluiert. Die Entwicklung von SmED erfolgt unter Einbeziehung von Vertretern des Marburger Bundes sowie der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) und Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI). Eine technische Integration mit der 112 ist in Arbeit.
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12
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Lawford BJ, Delany C, Bennell KL, Hinman RS. “I Was Really Pleasantly Surprised”: Firsthand Experience and Shifts in Physical Therapist Perceptions of Telephone‐Delivered Exercise Therapy for Knee Osteoarthritis–A Qualitative Study. Arthritis Care Res (Hoboken) 2019; 71:545-557. [DOI: 10.1002/acr.23618] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/05/2018] [Indexed: 12/15/2022]
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Keech JJ, Smith SR, Peden AE, Hagger MS, Hamilton K. The lived experience of rescuing people who have driven into floodwater: Understanding challenges and identifying areas for providing support. Health Promot J Austr 2018; 30:252-257. [PMID: 29893063 DOI: 10.1002/hpja.181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/08/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Drowning is a major public health issue, with risk increasing during times of flood. Driving into floodwater is a major risk factor for flood-related drowning and injury, and despite widespread public health campaigns, many people continue to undertake this risky behaviour and require rescue. PURPOSE We aimed to identify key challenges faced by emergency services personnel when rescuing those who have driven into floodwater, and to identify strategies for supporting rescuers in this important role. METHODS Australian flood rescue operators (N = 8) who had previously rescued a driver who had driven into floodwater participated in semi-structured interviews. Data were analysed using thematic analysis. RESULTS Four challenges emerged from their experiences: involvement of untrained personnel; varying information provided by emergency telephone operators; behaviour of drivers complicating the rescue; people sightseeing floods or flood rescues or ignoring closed roads providing rescuers with sources of distraction and frustration. CONCLUSIONS We propose five strategies for translating these results into practice, including: training and protocol development for (i) emergency personnel and (ii) telephone operators; (iii) training for rescuers regarding non-compliant rescuees; (iv) educating the public and (v) increasing compliance with closed roads. Current findings provide valuable insights into how rescuers can be supported in performing their roles, and implementation of these strategies has the potential to reduce fatalities occurring due to attempting to drive through floodwater. SO WHAT?: The strategies presented have the potential to reduce the frequency and improve the outcomes of floodwater rescues, aiding in the prevention of injury and death.
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Affiliation(s)
- Jacob J Keech
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Stephanie R Smith
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Amy E Peden
- Royal Life Saving Society - Australia, Broadway, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Martin S Hagger
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, WA, Australia.,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Health Psychology and Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, WA, Australia
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"I was really sceptical...But it worked really well": a qualitative study of patient perceptions of telephone-delivered exercise therapy by physiotherapists for people with knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:741-750. [PMID: 29572130 DOI: 10.1016/j.joca.2018.02.909] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Physiotherapists typically prescribe exercise therapy for people with osteoarthritis (OA) via face-to-face consultations. This study aimed to explore peoples' perceptions of exercise therapy delivered by physiotherapists via telephone for their knee OA. DESIGN A qualitative study (based on interpretivist methodology) embedded within a randomised controlled trial. Semi-structured individual interviews were conducted with 20 people with knee OA who had received exercise advice and support from one of eight physiotherapists via telephone over 6 months. Interviews were audio recorded, transcribed verbatim and thematically analysed. RESULTS Although people with OA were initially sceptical about receiving exercise therapy via telephone, they described mostly positive experiences, valuing the convenience and accessibility. However, some desired visual contact with the physiotherapist and suggested including video-conferencing calls or an initial in-person clinic visit. Participants valued the sense of undivided focus and attention they received from the physiotherapist and believed that they were able to communicate effectively via telephone. Participants felt confident performing their exercise program without supervision and described benefits including increased muscular strength, improved pain, and ability to perform tasks that they had not been previously able to. CONCLUSIONS People with knee OA held mostly positive perceptions about receiving exercise therapy from a physiotherapist via telephone, suggesting that such a service is broadly acceptable to consumers. Such services were generally not viewed as a substitute for face-to-face physiotherapy care, but rather as a new option that could increase accessibility of physiotherapy services, particularly for follow-up consultations.
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Njeru JW, Damodaran S, North F, Jacobson DJ, Wilson PM, St Sauver JL, Radecki Breitkopf C, Wieland ML. Telephone triage utilization among patients with limited English proficiency. BMC Health Serv Res 2017; 17:706. [PMID: 29121920 PMCID: PMC5679138 DOI: 10.1186/s12913-017-2651-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Communication between patients with limited English proficiency (LEP) and telephone triage services has not been previously explored. The purpose of this study was to determine the utilization characteristics of a primary care triage call center by patients with LEP. METHODS This was a retrospective cohort study of the utilization of a computer-aided, nurse-led telephone triage system by English proficiency status of patients empaneled to a large primary care practice network in the Midwest United States. Interpreter Services (IS) need was used as a proxy for LEP. RESULTS Call volumes between the 587 adult patients with LEP and an age-frequency matched cohort of English-Proficient (EP) patients were similar. Calls from patients with LEP were longer and more often made by a surrogate. Patients with LEP received recommendations for higher acuity care more frequently (49.4% versus 39.0%; P < 0.0004), and disagreed with recommendations more frequently (30.1% versus 20.9%; P = 0.0004). These associations remained after adjustment for comorbidities. Patients with LEP were also less likely to follow recommendations (60.9% versus 69.4%; P = 0.0029), even after adjusting for confounders (adjusted odds ratio [AOR] = 0.65; 95% confidence interval [CI], 0.49, 0.85; P < 0.001). CONCLUSION Patients with LEP who utilized a computer-aided, nurse-led telephone triage system were more likely to receive recommendations for higher acuity care compared to EP patients. They were also less likely to agree with, or follow, recommendations given. Additional research is needed to better understand how telephone triage can better serve patients with LEP.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Swathi Damodaran
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Frederick North
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Rochester, MN, USA
| | - Jennifer L St Sauver
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | | | - Mark L Wieland
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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17
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Midtbø V, Raknes G, Hunskaar S. Telephone counselling by nurses in Norwegian primary care out-of-hours services: a cross-sectional study. BMC FAMILY PRACTICE 2017; 18:84. [PMID: 28874124 PMCID: PMC5586064 DOI: 10.1186/s12875-017-0651-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
Background The primary care out-of-hours (OOH) services in Norway are characterized by high contact rates by telephone. The telephone contacts are handled by local emergency medical communication centres (LEMCs), mainly staffed by registered nurses. When assessment by a medical doctor is not required, the nurse often handles the contact solely by nurse telephone counselling. Little is known about this group of contacts. Thus, the aim of this study was to investigate characteristics of encounters with the OOH services that are handled solely by nurse telephone counselling. Methods Nurses recorded ICPC-2 reason for encounter (RFE) codes and patient characteristics of all patients who contacted six primary care OOH services in Norway during 2014. Descriptive statistics and frequency analyses were applied. Results Of all telephone contacts (n = 61,441), 23% were handled solely by nurse counselling. Fever was the RFE most frequently handled (7.3% of all nurse advice), followed by abdominal pain, cough, ear pain and general symptoms. Among the youngest patients, 32% of the total telephone contacts were resolved by nurse advice compared with 17% in the oldest age group. At night, 31% of the total telephone contacts were resolved solely by nurse advice compared with 21% during the day shift and 23% in the evening. The share of nurse advice was higher on weekdays compared to weekends (mean share 25% versus 20% respectively). Conclusion This study shows that nurses make a significant contribution to patient management in the Norwegian OOH services. The findings indicate which conditions nurses should be able to handle by telephone, which has implications for training and routines in the LEMCs. There is the potential for more nurse involvement in several of the RFEs with a currently low share of nurse counselling. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0651-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vivian Midtbø
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.
| | - Guttorm Raknes
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.,Regional Medicines Information & Pharmacovigilance Centre (RELIS), University Hospital of North Norway, Box 79, NO 9038, Tromsø, Norway.,Raknes Research, Myrdalskogen 243, NO 5117, Ulset, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Box 7804, NO 5018, Bergen, Norway
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The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews. BMC Health Serv Res 2017; 17:614. [PMID: 28854916 PMCID: PMC5577663 DOI: 10.1186/s12913-017-2564-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/22/2017] [Indexed: 11/17/2022] Open
Abstract
Background Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS. Methods We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews. Results Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators – access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care. Conclusions Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings. Electronic supplementary material The online version of this article (10.1186/s12913-017-2564-x) contains supplementary material, which is available to authorized users.
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Le TQ, Sánchez Y, Saini S, Sheridan R, Hirsch JA, Prabhakar AM. Improving the Interventional Radiology Patient Experience: Effect of a Phone Communication System Revision. J Am Coll Radiol 2017; 14:1045-1048. [DOI: 10.1016/j.jacr.2017.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Tran DT, Gibson A, Randall D, Havard A, Byrne M, Robinson M, Lawler A, Jorm LR. Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study. BMC Health Serv Res 2017; 17:512. [PMID: 28764695 PMCID: PMC5539620 DOI: 10.1186/s12913-017-2458-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Middle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call. Methods Records of calls to the Australian healthdirect helpline (July 2008–December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice “Attend ED immediately”; “See a doctor (immediately, within 4 hours, or within 24 hours)”; “Self-care”; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics. Results This study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices “Attend ED immediately”, “See a doctor” and “Self-care” were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice “Attend ED immediately” was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice “See a doctor” was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas, when another person made the call on the patient’s behalf, and when the original intention was to seek care from an ED or a doctor. It was lower among patients in rural and remote areas and those taking five medications or more. Patients aged ≥65 years were less likely to comply with the advice “Self-care”. The rates of self-referral to ED within 24 h were greater in patients from disadvantaged areas, among calls made after-hours or by another person, and when the original intention was to attend ED. Patients who were given a self-care or low-urgency care advice, whose calls concerned bleeding, cardiac, gastrointestinal, head and facial injury symptoms, were more likely to self-refer to ED. Conclusions Compliance with telephone triage advice among middle-age and older patients varied substantially according to both patient- and call-related factors. Knowledge about the patients who are less likely to comply with telephone triage advice, and about characteristics of calls that may influence compliance, will assist in refining patient triage protocols and referral pathways, training staff and tailoring service design and delivery to achieve optimal patient compliance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2458-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia.
| | - Amy Gibson
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Mary Byrne
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Maureen Robinson
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Anthony Lawler
- School of Medicine, University of Tasmania and Healthdirect Australia, Department of Health and Human Services, Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
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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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Odnoletkova I, Buysse H, Nobels F, Goderis G, Aertgeerts B, Annemans L, Ramaekers D. Patient and provider acceptance of telecoaching in type 2 diabetes: a mixed-method study embedded in a randomised clinical trial. BMC Med Inform Decis Mak 2016; 16:142. [PMID: 27825340 PMCID: PMC5101679 DOI: 10.1186/s12911-016-0383-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/02/2016] [Indexed: 11/17/2022] Open
Abstract
Background Despite advances in diagnosis and treatment of type 2 diabetes, suboptimal metabolic control persists. Patient education in diabetes has been proved to enhance self-efficacy and guideline-driven treatment, however many people with type 2 diabetes do not have access to or do not participate in self-management support programmes. Tele-education and telecoaching have the potential to improve accessibility and efficiency of care, but there is a slow uptake in Europe. Patient and provider acceptance in a local context is an important pre-condition for implementation. The aim of the study was to explore the perceptions of patients, nurses and general practitioners (GPs) regarding telecoaching in type 2 diabetes. Methods Mixed-method study embedded in a clinical trial, in which a nurse-led target-driven telecoaching programme consisting of 5 monthly telephone sessions of +/− 30 min was offered to 287 people with type 2 diabetes in Belgian primary care. Intervention attendance and satisfaction about the programme were analysed along with qualitative data obtained during post-trial semi-structured interviews with a purposive sample of patients, general practitioners (GPs) and nurses. The perceptions of patients and care providers about the intervention were coded and the themes interpreted as barriers or facilitators for adoption. Results Of 252 patients available for a follow-up analysis, 97.5 % reported being satisfied. Interviews were held with 16 patients, 17 general practitioners (GPs) and all nurses involved (n = 6). Themes associated with adoption facilitation were: 1) improved diabetes control; 2) need for more tailored patient education programmes offered from the moment of diagnosis; 3) comfort and flexibility; 4) evidence-based nature of the programme; 5) established cooperation between GPs and diabetes educators; and 6) efficiency gains. Most potential barriers were derived from the provider views: 1) poor patient motivation and suboptimal compliance with “faceless” advice; 2) GPs’ reluctance in the area of patient referral and information sharing; 3) lack of legal, organisational and financial framework for telecare. Conclusions Nurse-led telecoaching of people with type 2 diabetes was well-accepted by patients and providers, with providers being in general more critical in their reflections. With increasing patient demand for mobile and remote services in healthcare, the findings of this study should support professionals involved in healthcare policy and innovation. Trial registration NCT01612520, registered prior to recruitment on 4th June 2012. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0383-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I Odnoletkova
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 33, Leuven, B-3000, Belgium.
| | - H Buysse
- Department of Public Health, Ghent University, De Pintelaan 185, 4K3, 9000, Ghent, Belgium
| | - F Nobels
- Department of Endocrinology, OLV Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - G Goderis
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, Leuven, B-3000, Belgium
| | - B Aertgeerts
- Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33, Leuven, B-3000, Belgium
| | - L Annemans
- Department of Public Health, Ghent University, De Pintelaan 185, 4K3, 9000, Ghent, Belgium
| | - D Ramaekers
- Leuven Institute for Healthcare Policy, KU Leuven, Kapucijnenvoer 33, Leuven, B-3000, Belgium
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McKenzie R, Dunt D, Yates A. Patient intention and self-reported compliance in relation to emergency department attendance after using an after hours GP helpline. Emerg Med Australas 2016; 28:538-43. [DOI: 10.1111/1742-6723.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary McKenzie
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - David Dunt
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Allison Yates
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Vessey JA, McCrave J, Curro-Harrington C, DiFazio RL. Enhancing Care Coordination Through Patient- and Family-Initiated Telephone Encounters: A Quality Improvement Project. J Pediatr Nurs 2015; 30:915-23. [PMID: 26048646 DOI: 10.1016/j.pedn.2015.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
Abstract
Telehealth activities are often conducted by ambulatory nurses to assist with care coordination; these activities are especially important for children with complex, chronic conditions. This quality-improvement project examines specific components of nursing care delivered to children on the neurology and gastroenterology services through patient-initiated telephone encounters. Metrics and nurse-sensitive indicators explored include the type of services requested, the nurses' ability to resolve patients' concerns while eliminating otherwise unnecessary care, and associated costs with providing this care. The usefulness of a standardized instrument, the care coordination management tool, used in this project is discussed.
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Affiliation(s)
- Judith A Vessey
- Medicine Patient Services, Boston Children's Hospital, Boston, MA; Boston College, William F. Connell School of Nursing, Chestnut Hill, MA.
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Souza-Junior VD, Mendes IAC, Mazzo A, Godoy S. Application of telenursing in nursing practice: an integrative literature review. Appl Nurs Res 2015; 29:254-60. [PMID: 26856523 DOI: 10.1016/j.apnr.2015.05.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 04/18/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
Abstract
AIMS AND BACKGROUND Telenursing is the use of technological resources and communication systems to encourage the development of nursing. Its efficiency has been demonstrated to help countries overcome barriers to healthcare. This study investigates the current telenursing strategies utilized in nursing practice, as found in the literature. METHOD Integrative literature review of the application of telenursing, using the descriptors: telenursing, nursing care and communication means, in Portuguese, English and Spanish, between 2003 and 2013. RESULTS Telenursing is found particularly in care through telephone use for health services and orientations. The country with the largest number of research publications was the United States with 14 (37.8%), followed by Canada and the United Kingdom. FINAL CONSIDERATIONS It could be verified that telenursing is growing, in view of its presence in different countries, with strong evidence and benefits of its use. It proves to be an efficient tool to help countries overcome geographical barriers and provide health care information to the population.
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Affiliation(s)
- Valtuir Duarte Souza-Junior
- University of São Paulo at Ribeirão Preto College of Nursing-WHO Collaborating Centre for Nursing Research Development, Sao Paulo, Brazil.
| | - Isabel Amélia Costa Mendes
- University of São Paulo at Ribeirão Preto College of Nursing-WHO Collaborating Centre for Nursing Research Development, Sao Paulo, Brazil.
| | - Alessandra Mazzo
- University of São Paulo at Ribeirão Preto College of Nursing-WHO Collaborating Centre for Nursing Research Development, Sao Paulo, Brazil.
| | - Simone Godoy
- University of São Paulo at Ribeirão Preto College of Nursing-WHO Collaborating Centre for Nursing Research Development, Sao Paulo, Brazil.
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Navratil-Strawn JL, Ozminkowski RJ, Hartley SK. An economic analysis of a nurse-led telephone triage service. J Telemed Telecare 2014; 20:330-8. [PMID: 25059246 DOI: 10.1177/1357633x14545430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Telephone nurse lines help callers to select the most appropriate site and level of care for acute conditions. We examined whether compliance with nurse recommendations was associated with lower average health care expenditure, and identified the employer characteristics associated with higher than average savings. Telephone calls to a nurse-led help line made by commercial health plan members who worked for large employers were identified. The callers' intention before calling and the nurse recommendation regarding site/level of care were recorded. Compliance was determined using medical claims during a 30-day post-call observation period and was based on adherence to nurse recommendations. A total of 132,509 calls during 2012 were identified for the study. Nurse recommendations were that 31% of the callers seek a higher level of care than mentioned at the start of the call, 25% use a lower level of care and 44% pursue their originally intended level of care. After regression-based adjustment, the average medical expenditures were compared between compliers and non-compliers. Overall, 57% of callers were compliant with nurse recommendations. The average expenditures were $328 lower among compliant callers. A logistic regression analysis identified employer characteristics positively associated with achieving higher than average savings. These were having a low employee-to-dependent ratio, a headquarters in the Western region of the US, a low prospective health risk score, and participation by the employer in a targeted communication campaign. Compliance with the triage recommendations resulted in lower average health care expenditures, and several characteristics were positively associated with achieving higher savings.
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28
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Kim SW, Uhm JY, Im YM, Yun TJ, Park JJ, Park CS. [Outcomes of home monitoring after palliative cardiac surgery in infants with congenital heart disease]. J Korean Acad Nurs 2014; 44:228-36. [PMID: 24859128 DOI: 10.4040/jkan.2014.44.2.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Common conditions, such as dehydration or respiratory infection can aggravate hypoxia and are associated with interstage mortality in infants who have undergone palliative surgery for congenital heart diseases. This study was done to evaluate the efficacy of a home monitoring program (HMP) in decreasing infant mortality. METHODS Since its inception in May 2010, all infants who have undergone palliative surgery have been enrolled in HMP. This study was a prospective observational study and infant outcomes during HMP were compared with those of previous comparison groups. Parents were trained to measure oxygen saturation, body weight and feeding volume and to contact the hospital through the hotline for emergency situations. Telephone counseling was conducted by clinical nurse specialists every week post discharge. RESULTS Forty-one infants were enrolled in HMP. Nine hundred telephone counseling sessions were conducted. Seventy-three infants required telephone triage with the most common conditions being gastrointestinal (50.7%) and respiratory symptoms (32.9%). With HMP intervention, interstage mortality decreased from 18.6% (8/43) to 9.8% (4/41) (χ²=1.15, p=.283). CONCLUSION Results indicate that active measures and treatments using the HMP decrease mortality rates, however further investigation is required to identify various factors that contribute to hemodynamic complications during the interstage period.
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Affiliation(s)
- Sang Wha Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Ju Yeon Uhm
- Department of Nursing, Asan Medical Center, Seoul, Korea.
| | - Yu Mi Im
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Tae Jin Yun
- College of Medicine, Ulsan University, Seoul, Korea
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de Graaf M, Totte J, Breugem C, van Os-Medendorp H, Pasmans S. Evaluation of the Compliance, Acceptance, and Usability of a Web-Based eHealth Intervention for Parents of Children With Infantile Hemangiomas: Usability Study. JMIR Res Protoc 2013; 2:e54. [PMID: 24345450 PMCID: PMC3875905 DOI: 10.2196/resprot.2897] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/30/2013] [Accepted: 10/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Infantile hemangiomas (IH) are common benign vascular tumors in children. Recognition and timely referral of high risk IH to specialized centers is important. This might be achieved by involving parents in the care for IH by means of an eHealth intervention. Objective The objective of our study was to evaluate parent compliance, acceptance, and usability of an open access, Web-based eHealth intervention (including e-learning and e-consult) designed to increase parents’ knowledge and (risk) evaluation of IH. Methods A cross-sectional study of parents who completed the eHealth intervention between October 2010 and November 2012 was carried out. All parents were sent a study questionnaire. Questions to evaluate compliance (to the advice given by a dermatologist during e-consultation) were asked. Acceptance and usability were evaluated by using the modified Technology Acceptance Model. Results A total of 224 parents completed the eHealth intervention and received the questionnaire, 135/224 parents responded (response rate was 60.3%). There were 128/135 questionnaires that were completed and included. A total of 110/128 (85.9%) parents were compliant to the advice of the dermatologist. There were 116.8/128 (91.3%) that perceived the eHealth intervention as useful and almost all parents (98.4%, 126/128) found the information in the e-learning clear. There were 29/128 (22.7%) that experienced technical problems. The majority of the parents (94.5%, 121/128) found the eHealth intervention reliable and most of them (98.4%, 126/128) would recommend the eHealth intervention to other parents. Noncompliant parents judged the eHealth intervention significantly less reliable compared to compliant parents (71%, 10/14 versus 97.3%, 107/110; P=.003). Conclusions Parents of children with an IH showed a high compliance (85.9%, 110/128) to the advice of the dermatologist given via our Web-based eHealth intervention. This high compliance might be positively influenced by the good acceptance and usability of the eHealth intervention and might result in timely presentation and treatment of children with high risk IH in specialized centers.
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Affiliation(s)
- Marlies de Graaf
- Wilhelmina Children's Hospital, Department of Pediatric Dermatology and Allergology, University Medical Center Utrecht, Utrecht, Netherlands.
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