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Mills EHA, Møller AL, Gnesin F, Zylyftari N, Jensen B, Christensen HC, Blomberg SN, Kragholm KH, Gislason G, Køber L, Gerds T, Folke F, Lippert F, Torp-Pedersen C, Andersen MP. Association between mortality and phone-line waiting time for non-urgent medical care: a Danish registry-based cohort study. Eur J Emerg Med 2024; 31:127-135. [PMID: 37788126 DOI: 10.1097/mej.0000000000001088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND AND IMPORTANCE Telephone calls are often patients' first healthcare service contact, outcomes associated with waiting times are unknown. OBJECTIVES Examine the association between waiting time to answer for a medical helpline and 1- and 30-day mortality. DESIGN, SETTING AND PARTICIPANTS Registry-based cohort study using phone calls data (January 2014 to December 2018) to the Capital Region of Denmark's medical helpline. The service refers to hospital assessment/treatment, dispatches ambulances, or suggests self-care guidance. EXPOSURE Waiting time was grouped into the following time intervals in accordance with political service targets for waiting time in the Capital Region: <30 s, 0:30-2:59, 3-9:59, and ≥10 min. OUTCOME MEASURES AND ANALYSIS The association between time intervals and 1- and 30-day mortality per call was calculated using logistic regression with strata defined by age and sex. MAIN RESULTS In total, 1 244 252 callers were included, phoning 3 956 243 times, and 78% of calls waited <10 min. Among callers, 30-day mortality was 1% (16 560 deaths). For calls by females aged 85-110 30-day mortality increased with longer waiting time, particularly within the first minute: 9.6% for waiting time <30 s, 10.8% between 30 s and 1 minute and 9.1% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 11.1%, 12.9% and 11.1%, respectively. Additionally, among calls with a Charlson score of 2 or higher, longer waiting times were likewise associated with increased mortality. For calls by females aged 85-110 30-day mortality was 11.6% for waiting time <30 s, 12.9% between 30 s and 1 minute and 11.2% between 1 and 2 minutes. For calls by males aged 85-110 30-day mortality was 12.7%, 14.1% and 12.6%, respectively. Fewer ambulances were dispatched with longer waiting times (4%/2%) with waiting times <30 s and >10 min. CONCLUSION Longer waiting times for telephone contact to a medical helpline were associated with increased 1- and 30-day mortality within the first minute, especially among elderly or more comorbid callers.
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Affiliation(s)
| | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød
| | - Nertila Zylyftari
- Department of Cardiology, Nordsjællands Hospital, Hillerød
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
| | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
- Danish Clinical Quality Program - National Clinical Registries (RKKP), Righospitalet, Copenhagen
| | | | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- The Danish Heart Foundation
| | - Lars Køber
- Department of Cardiology, Rigshospitalet
| | - Thomas Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen and University of Copenhagen
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg
- Department of Cardiology, Nordsjællands Hospital, Hillerød
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Turner J, Knowles E, Simpson R, Sampson F, Dixon S, Long J, Bell-Gorrod H, Jacques R, Coster J, Yang H, Nicholl J, Bath P, Fall D. Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
The NHS emergency and urgent care system is under pressure as demand for services increases each year. NHS 111 is a telephone triage service designed to provide advice and signposting to appropriate services for people with urgent health-care problems. A new service, NHS 111 Online, has been introduced across England as a digital alternative that can be accessed using a website or a smartphone application. The effects and usefulness of this service are unknown.
Objectives
To explore the impact of NHS 111 Online on the related telephone service and urgent care system activity and the experiences of people who use those services.
Design and methods
A mixed-methods design of five related work packages comprising an evidence review; a quantitative before-and-after time series analysis of changes in call activity (18/38 sites); a descriptive comparison of telephone and online services with qualitative survey (telephone, n = 795; online, n = 3728) and interview (32 participants) studies of service users; a qualitative interview study (16 participants) of staff; and a cost–consequences analysis.
Results
The online service had little impact on the number of triaged calls to the NHS 111 telephone service. For every 1000 online contacts, triaged telephone calls increased by 1.3% (1.013, 95% confidence interval 0.996 to 1.029; p = 0.127). Recommendations to attend emergency and urgent care services increased between 6.7% and 4.2%. NHS 111 Online users were less satisfied than users of the telephone service (50% vs. 71%; p < 0.001), and less likely to recommend to others (57% vs. 69%; p < 0.001) and to report full compliance with the advice given (67.5% vs. 88%; p < 0.001). Online users were less likely to report contacting emergency services and more likely to report not making any contact with a health service (31% vs. 16%; p < 0.001) within 7 days of contact. Thirty-five per cent of online users reported that they did not want to use the telephone service, whereas others preferred its convenience and speed. NHS 111 telephone staff reported no discernible increase or decrease in their workload during the first year of operation of NHS 111 Online. If online and telephone services operate in parallel, then the annual costs will be higher unless ≥ 38% of telephone contacts move to online contacts.
Conclusions
There is some evidence that the new service has the potential to create new demand. The service has expanded significantly, so it is important to find ways of promoting the right balance in numbers of people who use the online service instead of the telephone service if it is to be effective. There is a clear need and preference by some people for an online service. Better information about when to use this service and improvements to questioning may encourage more uptake.
Limitations
The lack of control arm means that impact could have been an effect of other factors. This work took place during the early implementation phase, so findings may change as the service expands.
Future work
Further development of the online triage process to make it more ‘user friendly’ and to enable users to trust the advice given online could improve use and increase satisfaction. Better understanding of the characteristics of the telephone and online populations could help identify who is most likely to benefit and could improve information about when to use the service.
Trial registration
Current Controlled Trials ISRCTN51801112.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Janette Turner
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Knowles
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rebecca Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Fiona Sampson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Dixon
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jaqui Long
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Bell-Gorrod
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Hui Yang
- School of Information Studies, University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Peter Bath
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- School of Information Studies, University of Sheffield, Sheffield, UK
| | - Daniel Fall
- Sheffield Emergency Care Forum, Sheffield, UK
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3
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Ebert JF, Huibers L, Christensen B, Collatz Christensen H, Christensen MB. Does an emergency access button increase the patients' satisfaction and feeling of safety with the out-of-hours health services? A randomised controlled trial in Denmark. BMJ Open 2020; 10:e030267. [PMID: 32998912 PMCID: PMC7528355 DOI: 10.1136/bmjopen-2019-030267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate if the option to bypass the telephone queue can increase satisfaction and feeling of safety in callers. DESIGN Randomised controlled parallel superiority trial. Data from questionnaire survey. SETTING Two out-of-hours (OOH) services in Denmark. PARTICIPANTS 217 510 citizens who called the OOH services between 4 September 2017 and 30 November 2017. RANDOMISATION Two-faze study period: First half with randomisation of participants based on their date of birth; even date randomised to intervention, uneven date randomised to control group. Second half with all participants included in intervention group. INTERVENTION Providing randomised callers (intervention group n=146 355) with the option to bypass the telephone waiting line through an emergency access button (EAB), while the rest got the normal service (control group n=71 155). All EAB users were invited to a questionnaire survey as well as random participants who did not use the EAB (of whom approximately 50% did not have the EAB option). MAIN OUTCOME MEASURES Satisfaction and feeling of safety in callers. RESULTS 2208 of 6704 (32.9%) invited callers answered the questionnaire (intervention group n=1415 (users n=621, non-users n=794); control group n=793). The OR for answering in the two categories with highest satisfaction when provided with the EAB option was 1.34 (95% CI 1.07 to 1.68) for satisfaction with the waiting time, 1.21 (95% CI 0.91 to 1.60) for overall satisfaction and 1.46 (95% CI 1.12 to 1.89) for feeling of safety. Approximately 72% (441/621) of EAB users reported that the EAB option increased their feeling of safety with the OOH services 'to a high degree' compared with 25% (197/794) of callers who had the EAB option without using it. CONCLUSIONS The EAB can provide fast access to OOH telephone advice in case of severe illness. It favours citizens perceived in most need of urgent healthcare and significantly increases both feeling of safety and patient satisfaction. TRIAL REGISTRATION DETAILS NCT02572115 (5 October 2015).
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Affiliation(s)
- Jonas Fynboe Ebert
- Research Unit for General Practice, Aarhus Universitet Health, Aarhus, Denmark
| | - L Huibers
- Research Unit for General Practice, Aarhus Universitet, Aarhus, Denmark
| | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Frederiksberg, Denmark
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres. J Patient Rep Outcomes 2020; 4:79. [PMID: 32936378 PMCID: PMC7494691 DOI: 10.1186/s41687-020-00243-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility. RESULTS The pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach's α = 0.93). The PEI score diminished strongly over the two-week period. CONCLUSIONS The PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland. .,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland
| | - Mika Helminen
- Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, Tampere University, c/o coordinator Leena Kiuru, Arvo Building B, 33014, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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5
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Tolvanen E, Groenewegen PP, Koskela TH, Bjerve Eide T, Cohidon C, Kosunen E. Patient enablement after a consultation with a general practitioner-Explaining variation between countries, practices and patients. Health Expect 2020; 23:1129-1143. [PMID: 32602205 PMCID: PMC7696125 DOI: 10.1111/hex.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. OBJECTIVE To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. DESIGN We constructed multi-level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. SETTING AND PARTICIPANTS A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. RESULTS In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient-level and only a few practice-level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health-care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. DISCUSSION AND CONCLUSIONS There are large differences in patient enablement between GPs and countries. Patient characteristics and patients' perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient-reported measures as an indicator of health-care system performance, researchers should be aware of the influence of cultural elements.
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Affiliation(s)
- Elina Tolvanen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Pirkkala Municipal Health Centre, Pirkkala, Finland.,Science Centre, Pirkanmaa Hospital District, Tampere, Finland
| | - Peter P Groenewegen
- Nivel-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Department of Sociology, Utrecht University, Utrecht, The Netherlands.,Department of Human Geography, Utrecht University, Utrecht, The Netherlands
| | - Tuomas H Koskela
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Elise Kosunen
- Faculty of Medicine and Health Technology, c/o coordinator Leena Kiuru, Tampere University, Tampere, Finland.,Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland
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7
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Chan JMH, Fang AHS, Shah M. Factors affecting patient enablement in an Asian setting: a mixed methods study. Singapore Med J 2019; 61:647-660. [PMID: 31598731 DOI: 10.11622/smedj.2019125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Patient-centred medical care has been rising in importance since the turn of the century. It entails treating patients in relation to their biopsychosocial outlook so as to support the management of their conditions. The extent to which a patient is enabled to acquire skills and knowledge can be measured with the Patient Enablement Instrument (PEI) proposed by Howie and colleagues, and it has been noted to be more reflective of a good consultation compared to patient satisfaction scores. This study aimed to determine the level of patient enablement in the Singaporean context and the factors facilitating it. METHODS We conducted an embedded mixed method study with primary care patients in two phases: (a) a PEI questionnaire was completed by 150 patients; and (b) a qualitative approach using focused group discussions and individual interviews was used to explore factors associated with high enablement. RESULTS The mean PEI score was 4.5 ± 4.4, with significantly higher scores among patients attending specialised primary care clinics. Important physician factors were doctors' advice, attitude and relationship with the patient. Critical system factors included good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust, with considerable impact from the influence of community. CONCLUSION The PEI score in the Singaporean context is similar to that of other Asian contexts, but slightly higher than that reported in Western studies. Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement.
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Zinger ND, Blomberg SN, Lippert F, Collatz Christensen H. Satisfaction of 30 402 callers to a medical helpline of the Emergency Medical Services Copenhagen: a retrospective cohort study. BMJ Open 2019; 9:e029801. [PMID: 31597649 PMCID: PMC6797474 DOI: 10.1136/bmjopen-2019-029801] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To keep healthcare systems sustainable for future demands, many countries are developing a centralised telephone line for out-of-hours primary care services. To increase the quality of such services, more information is needed on factors that influence caller satisfaction. The aim of this study was to identify demographic and call-related characteristics that are associated with the patient satisfaction of callers to a medical helpline in Denmark. DESIGN Retrospective cohort study on patient registry data and questionnaire results. SETTING Non-emergency medical helpline in the Capital Region of Denmark. PARTICIPANTS A random sample of 30 402 callers to the medical helpline between May 2016 and May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Responses of a satisfaction questionnaire were linked to demographic and call-related dispatch data. Associations between the characteristics were analysed with multivariable logistic regression analysis with satisfaction as the dependent variable. A subgroup analysis was performed on callers for children aged between 0 and 4 years. RESULTS Of the 30 402 analysed callers, 73.0% were satisfied with the medical helpline. Satisfaction was associated with calling for a somatic injury (OR: 1.96, 95% CI: 1.72 to 2.23), receiving a face-to-face consultation (OR: 2.27, 95% CI: 2.04 to 2.50) and a waiting time less than 10 min (OR: 1.82, 95% CI: 1.56 to 2.08). Callers for a 0-year to 4-year-old patient were more likely to be satisfied when they called for a somatic illness or received a telephone consultation, compared with the rest of the population (p<0.0001). CONCLUSION Callers were in general satisfied with the medical helpline. Satisfaction was associated with reason for encounter, triage response and waiting time. People calling for 0-year to 4-year-old patients were, compared with the rest of the population, more frequently satisfied when they called for a somatic illness or received a telephone consultation.
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Affiliation(s)
- Nienke Doreen Zinger
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Stig Nikolaj Blomberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
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9
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Lous J, Moth G, Huibers L, Vedsted P, Christensen MB. Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations. BMC FAMILY PRACTICE 2019; 20:36. [PMID: 30808295 PMCID: PMC6390329 DOI: 10.1186/s12875-019-0922-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The demand for out-of-hours (OOH) primary care has increased during the last decades, with a considerable amount of contacts for young children. This study aims to describe the reasons for encounter (RFE), the most common diagnoses, the provided care, and the parental satisfaction with the general practitioner (GP) led OOH service in a Danish population of children (0-5 years). METHODS We conducted a one-year cross-sectional study based on data for 2363 randomly selected contacts concerning children from a survey on OOH primary care including 21,457 patients in Denmark. For each contact, the GPs completed an electronic pop-up questionnaire in the patient's medical record. Questionnaire items focussed on RFE, health problem severity, diagnosis, provided care, and satisfaction. The parents subsequently received a postal questionnaire. RESULTS The most common RFE was non-specific complaints (40%), followed by respiratory tract symptoms (23%), skin symptoms (9%), and digestive organ symptoms (8%). The most common diagnosis group was respiratory tract diseases (41%), followed by general complaints (19%) and ear diseases (16%). Prescriptions were dispensed for 27% of contacts, and about ¾ were for antibiotics. A total of 12% contacts concerned acute otitis media; antibiotics were prescribed in 70%. A total of 38% of contacts concerned fever, and ¼ got antibiotics. A total of 7.4% were referred for further evaluation. The parental satisfaction was generally high, but 7.0% were dissatisfied. Dissatisfaction was correlated with low prescription rate. CONCLUSION Respiratory tract diseases were the most common diagnoses. The GPs at the OOH primary care service referred children to hospital in 7.4% of the face-to-face consultations, and the provided care was evaluated as non-satisfying by only 7.0% of the parents. Clinical implications of the findings mean room for less prescription of antibiotic to children with ear diseases and a need for research in factors related to dissatisfaction.
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Affiliation(s)
- Jørgen Lous
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Jagtvej 20A, DK-8270, Højbjerg, Denmark.
| | - Grete Moth
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark.,Research Unit for General Practice & section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Tolvanen E, Koskela TH, Helminen M, Kosunen E. Patient Enablement After a Single Appointment With a GP: Analysis of Finnish QUALICOPC Data. J Prim Care Community Health 2017; 8:213-220. [PMID: 28911251 PMCID: PMC5932738 DOI: 10.1177/2150131917730211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Patient enablement is described as patient’s ability to understand and cope with illness after a consultation. The purpose of this study was to analyze factors associated with enablement in Finnish primary health care. An additional aim was to evaluate whether a single question could be used to measure enablement. Methods: A questionnaire survey was addressed to Finnish general practitioners (GPs) within the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. A trained fieldworker contacted nine patients for every participating GP. Two to 9 patients per GP (median 9 patients) completed the questionnaire. Patient enablement was measured by a single question based on the Patient Enablement Instrument questionnaire. Multivariate and multilevel analyses were performed to find variables that have an independent association with patient enablement. Results: A total of 1196 patients completed the QUALICOPC questionnaire. A total of 898 patients (75.1%) agreed that they felt better able to cope with their health problem or illness after an appointment with a GP, reflecting patient enablement. In the theme group analyses, 11 factors were found to have a statistically significant (P < .05) association with enablement. In the final multivariable model, positive perceptions of doctor-patient communication and patient satisfaction were positively associated with enablement. Conclusions: The results, using a single question to measure enablement, are comparable to previous findings on factors associated with enablement. Further research is needed and these results should be regarded as preliminary.
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Affiliation(s)
- Elina Tolvanen
- 1 University of Tampere, Tampere, Finland.,2 Pirkkala Municipal Health Centre, Pirkkala, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | | | - Mika Helminen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
| | - Elise Kosunen
- 1 University of Tampere, Tampere, Finland.,3 Pirkanmaa Hospital District, Tampere, Finland
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11
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Ebert JF, Huibers L, Lippert FK, Christensen B, Christensen MB. Development and evaluation of an "emergency access button" in Danish out-of-hours primary care: a study protocol of a randomized controlled trial. BMC Health Serv Res 2017; 17:379. [PMID: 28566087 PMCID: PMC5452428 DOI: 10.1186/s12913-017-2308-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Out-of-hours (OOH) health care for acute medical problems is often challenged by long waiting time for callers in need of advice and triage. Allowing patients to bypass the OOH telephone waiting line may increase patient satisfaction and provide them with a feeling of safety. We aimed to develop an "emergency access button" enabling patients to bypass the normal telephone waiting line in out-of-hours primary care (OOH-PC) if they perceive their condition to be critical and to evaluate the effect of introducing the button in terms of patient satisfaction and their feeling of safety. METHODS All patients calling the OOH-PC in two different Danish health care regions during three months will be included in this randomized controlled trial. Data will be collected through two questionnaires developed for this study: a pop-up questionnaire on the relevance of bypassing the normal waiting line to be completed by triage professionals after patient contact and a paper/electronic questionnaire on perceived safety and satisfaction with the emergency access button to be completed by the callers. These questionnaires were developed and validated using external and internal expert feedback, focus group interviews and a two-week field test. The study will be conducted over three months with an estimated user-rate of the emergency access button of 3%. DISCUSSION We have developed an emergency access button and we now want to investigate whether this new option will influence upon the level of satisfaction and the feeling of safety in the calling patients. Additionally, the study will reveal the assessed relevance of the decision to bypass the line by triage professionals. TRIAL REGISTRATION Registered as NCT02572115 at Clinicaltrials.gov on October 5th 2015.
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Affiliation(s)
- J F Ebert
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. .,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.
| | - L Huibers
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - F K Lippert
- Emergency Medical Services Copenhagen, The Capital Region of Denmark, Telegrafvej 5, DK-2750, Ballerup, Copenhagen, Denmark
| | - B Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
| | - M B Christensen
- Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark.,Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark
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Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, Richards DA, Richards SH, Salisbury C, Taylor RS, Calitri R, Bowyer V, Chaplin K, Kandiyali R, Murdoch J, Price L, Roscoe J, Varley A, Warren FC. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technol Assess 2015; 19:1-212, vii-viii. [PMID: 25690266 DOI: 10.3310/hta19130] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice. OBJECTIVES In comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice. DESIGN Pragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation. SETTING General practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk). PARTICIPANTS Patients requesting same-day consultations. INTERVENTIONS Practices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation. MAIN OUTCOME MEASURES Primary - primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary - resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care. RESULTS Of 20,990 eligible randomised patients (UC n = 7283; GPT n = 6695; NT n = 7012), primary outcome data were analysed for 16,211 patients (UC n = 5572; GPT n = 5171; NT n = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient-clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it. CONCLUSIONS Introducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented. TRIAL REGISTRATION Current Controlled Trials ISRCTN20687662. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Emily Fletcher
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Nicky Britten
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Colin Green
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Tim Holt
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Valerie Lattimer
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - David A Richards
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Suzanne H Richards
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Raff Calitri
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Vicky Bowyer
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Chaplin
- Institute of Health Service Research, University of Exeter Medical School, Exeter, UK
| | - Rebecca Kandiyali
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Jamie Murdoch
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Linnie Price
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | - Julia Roscoe
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anna Varley
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, Exeter, UK
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13
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Mounce LTA, Barry HE, Calitri R, Henley WE, Campbell J, Roland M, Richards S. Establishing the validity of English GP Patient Survey items evaluating out-of-hours care. BMJ Qual Saf 2015; 25:842-850. [PMID: 26490002 PMCID: PMC5136712 DOI: 10.1136/bmjqs-2015-004215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/13/2015] [Accepted: 09/26/2015] [Indexed: 11/26/2022]
Abstract
Background A 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users’ experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items. Objectives Establish the construct and concurrent validity of GPPS items evaluating service users’ experience of GP out-of-hours care. Methods Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the ‘entry access’ (four items) and ‘consultation satisfaction’ (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions. Results The modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the ‘entry access’ scores (r=0.63) and 44.0% of variation in the ‘consultation satisfaction’ scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ. Conclusions Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users’ overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.
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Affiliation(s)
- Luke T A Mounce
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Heather E Barry
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Raffaele Calitri
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - William E Henley
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - John Campbell
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Martin Roland
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Suzanne Richards
- Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, University of Exeter, Exeter, UK
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14
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Bernthal EM, Lathlean J, Gobbi M, Simpson RG. Mothers' decision-making during times of stress as a lone parent: a qualitative study. J ROY ARMY MED CORPS 2015; 161 Suppl 1:i26-i33. [PMID: 26419524 DOI: 10.1136/jramc-2015-000526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Little empirical evidence exists to identify the impact that a partner's absence or presence has on the mother's decision-making and her consequential help-seeking behaviour when her child is unwell. METHODS This study used a qualitative design in three phases using focus groups and interviews to explore Army mothers' help-seeking behaviour as a lone parent when their child was unwell during the out-of-hours period. Thirty-one parents from a British Army garrison were interviewed. RESULTS The findings demonstrated that Army life created a combination of stressors for Army mothers, which altered their help-seeking behaviour when their child was unwell. When their partner was available, mothers contacted health services as a last resort, once all other avenues had been exhausted. However, in contrast, in their partners' absence, they were contacted as a first resort. CONCLUSION An algorithm was generated from the findings, which illustrates the importance of ascertaining whether the mother is alone at the time of the consultation. Increased emotional vulnerability intensified the need for reassurance and affected a mother's decision-making ability. Primary healthcare staff should ascertain whether mothers are currently lone parents at an early stage of their assessment, as this may influence the entire consultation.
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Affiliation(s)
- Elizabeth Mm Bernthal
- Royal Centre for Defence Medicine (Research and Academic), Birmingham, W Midlands, UK
| | - J Lathlean
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - M Gobbi
- Faculty of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - R G Simpson
- Dean, Defence Medical Services, Defence Healthcare Education and Training, Lichfield, UK
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15
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Frost J, Currie MJ, Cruickshank M. An Integrative Review of Enablement in Primary Health Care. J Prim Care Community Health 2015; 6:264-78. [PMID: 26229059 DOI: 10.1177/2150131915598373] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To review how enablement is conceptualized and practiced in primary health care and to explore the factors that influence patient enablement in this setting. METHOD A narrative integrative literature review was undertaken. RESULTS Twenty-four articles specifically relating to enablement in primary health care were identified. Three literature reviews, 4 qualitative studies, and 17 quantitative studies were included in the analysis. CONCLUSIONS In the primary health care setting, the concept of enablement is well defined as an outcome measure of quality. The literature exploring the practice of enablement is sparse, but 2 randomized controlled trials suggest enablement is linked to better outcomes for patients with asthma and diabetes. Primary factors influencing enablement included the practitioners' open communication style, the degree to which the practitioner is patient centered, and longer consultations. Other factors found to be associated with enablement were the presenting health issue, general state of health, ethnicity, the patient's own coping strategies and degree of independence, and socioeconomic status. The association between enablement and patients' expectations and satisfaction is less clear. The majority of research on enablement was carried out among general practitioners. Further research into the degree to which patients are enabled by a wider range of health care providers is needed. Additional qualitative research would provide a deeper understanding of the attributes of enablement in the primary health care setting.
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Affiliation(s)
- Jane Frost
- University of Canberra, Canberra, Australia
| | - Marian J Currie
- University of Canberra, Canberra, Australia Australian National University, Canberra, Australia
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Leutgeb R, Walker N, Remmen R, Klemenc-Ketis Z, Szecsenyi J, Laux G. On a European collaboration to identify organizational models, potential shortcomings and improvement options in out-of-hours primary health care. Eur J Gen Pract 2014; 20:233-7. [PMID: 24654834 DOI: 10.3109/13814788.2014.887069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Abstract Background: Out-of-hours care (OOHC) provision is an increasingly challenging aspect in the delivery of primary health care services. Although many European countries have implemented organizational models for out-of-hours primary care, which has been traditionally delivered by general practitioners, health care providers throughout Europe are still looking to resolve current challenges in OOHC. It is within this context that the European Research Network for Out-of-Hours Primary Health Care (EurOOHnet) was established in 2010 to investigate the provision of out-of-hours care across European countries, which have diverse political and health care systems. In this paper, we report on the EurOOHnet work related to OOHC organizational models, potential shortcomings and improvement options in out-of-hours primary health care. Needs assessment: The EurOOHnet expert working party proposed that models for OOHC should be reviewed to evaluate the availability and accessibility of OOHC for patients while also seeking ways to make the delivery of care more satisfying for service providers. OUTCOMES To move towards resolution of OOHC challenges in primary care, as the first stage, the EurOOHnet expert working party identified the following key needs: clear and uniform definitions of the different OOHC models between different countries; adequate-ideally transnational-definitions of urgency levels and corresponding data; and educational programmes for nurses and doctors (e.g. in the use of a standardized triage system for OOHC). Finally, the need for a modern system of data transfer between different health care providers in regular care and providers in OOHC to prevent information loss was identified.
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Affiliation(s)
- Ruediger Leutgeb
- Department of General Practice and Health Services Research, University of Heidelberg , Heidelberg , Germany
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Allemann Iseli M, Kunz R, Blozik E. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review. Patient Prefer Adherence 2014; 8:893-907. [PMID: 25028538 PMCID: PMC4077851 DOI: 10.2147/ppa.s56160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. OBJECTIVES Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. METHODS We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. RESULTS We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. CONCLUSION A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation.
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Affiliation(s)
| | - Regina Kunz
- Academy of Swiss Insurance Medicine, University of Basel, Basel, Switzerland
| | - Eva Blozik
- Swiss Center for Telemedicine Medgate, Basel, Switzerland
- Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse, Hamburg, Germany
- Correspondence: Eva Blozik, Department of Primary Medical Care, University Medical Center Hamburg–Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany, Tel +49 40 741 052 400, Fax +49 40 741 053 681, Email
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Brown S, Henderson E, Howse J, Rubin G. Patient views of single number access to urgent care services. Fam Pract 2012; 29:713-8. [PMID: 22417779 DOI: 10.1093/fampra/cms023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In October 2009, NHS County Durham and Darlington introduced a single point of access telephone number for people requiring out-of-hours health care. We evaluated users' views and experiences of the service. METHODS We used a validated questionnaire adapted for use in telephone interviews, with open-ended questions added to allow people to express their views. Interviews were carried out with 493 people who had used the urgent care line between April and July 2010 of 1626 telephone calls made, a response rate of 30.3%. SPSS 17.0 was used to analyse the quantitative data and Framework analysis the qualitative data. RESULTS We found that (i) regardless of age or gender people who used the call line were satisfied with the service they received, (ii) the call line advised most cases to go to an urgent care centre, (iii) people who received advice other than that expected were still satisfied with the service. Criticisms of the service related to confusion about accessing the service and which number callers should use. CONCLUSIONS We found very high levels of satisfaction across all groups for a single point of access telephone number for urgent care. Clear information about the service, in particular that it will involve telephone triage and that access to a doctor or nurse is not immediate, may also resolve some instances of dissatisfaction. It appears that the service is effective in directing people to places where they can be dealt with appropriately.
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Affiliation(s)
- Sally Brown
- School of Medicine and Health, Queen's Campus, Durham University, University Boulevard, Thornaby on Tees TS17 6BH, UK.
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Poole R, Gamper A, Porter A, Egbunike J, Edwards A. Exploring patients' self-reported experiences of out-of-hours primary care and their suggestions for improvement: a qualitative study. Fam Pract 2011; 28:210-9. [PMID: 21059702 PMCID: PMC3062781 DOI: 10.1093/fampra/cmq090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Out-of-hours services for primary care provision are increasing in policy relevance. The aim of this qualitative study was to explore service users' recent experiences of out-of-hours services and to identify suggestions for improvement for services and practitioners involved. METHODS We used data from a cross-sectional survey of service users' self-reported experiences of 13 out-of-hours centres in Wales. Three hundred and forty-one respondents provided free-text comments focusing on suggestions for improvement within the survey instrument (the Out-of-hours Patient Questionnaire). A coding framework was based on previous literature focusing on patients' experiences of out-of-hours services, built upon and refined as it was systematically applied to the data. Emergent themes and subthemes were charted and interpreted to comprise the findings. RESULTS Central themes emerged from users' perspectives of the structure of out-of-hours services, process of care and outcomes for users. Themes included long waiting times, perceived quality of service user-practitioner communication, consideration for parents and children and accessibility of the service and medication. Suggestions for improving care were made across these themes, including triaging patients more effectively and efficiently, addressing specific aspects of practitioners' communication with patients, reconsidering the size of areas covered by services and number of professionals required for the population covered, extending GP and pharmacy opening times and medication delivery services. CONCLUSIONS It is important to consider ways to address service users' principal concerns surrounding out-of-hours services. Debate is required about prioritizing and implementing potential improvements to out-of-hours services in the light of resource constraints.
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Affiliation(s)
- Ria Poole
- Clinical Epidemiology Interdisciplinary Research Group, Department of Primary Care and Public Health, Cardiff University, Heath Park, Cardiff CF14 4YS, UK
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