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Fotland SLS, Midtbø V, Vik J, Zakariassen E, Johansen IH. Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review. Syst Rev 2024; 13:162. [PMID: 38909273 PMCID: PMC11193260 DOI: 10.1186/s13643-024-02580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/10/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review was to identify such factors and to describe how they affect communication during telephone triage. METHOD A mixed-method systematic review was performed. In April 2021 and June 2023, MEDLINE, Embase, CINAHL, and Web of Science were searched for original studies describing communication during telephone triage in primary care medical call centres handling all types of medical problems from an unselected population. All studies were screened by two authors, blinded to each other's decisions. Disagreements were resolved by a third author. A framework was created by the thematic synthesis of the qualitative data and later used to synthesise the quantitative data. By using convergent integrated synthesis, the qualitative and quantitative findings were integrated. The Mixed Methods Appraisal Tool was used to assess methodological limitations. RESULTS Out of 5087 studies identified in the search, 62 studies were included, comprising 40 qualitative, 16 quantitative and six mixed-method studies. Thirteen factors were identified and organised into four main themes: organisational factors, factors related to the operator, factors related to the caller and factors in the interaction. Organisational factors included availability, working conditions and decision support systems. Factors related to the operator were knowledge and experience, personal qualities and communication strategies. Factors related to the caller were individual differences and the presented medical problem. Factors in the interaction were faceless communication, connection between operator and caller, third-person caller and communication barriers. The factors seem interrelated, with organisational factors affecting all parts of the conversation, and the operator's communication in particular. CONCLUSION Many factors affect the structure, content, and flow of the conversation. The operators influence the communication directly but rely on the organisation to create a working environment that facilitates good communication. The results are mainly supported by qualitative studies and further studies are needed to explore and substantiate the relevance and effect of individual factors. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022298022.
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Affiliation(s)
- Siri-Linn Schmidt Fotland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway.
| | - Vivian Midtbø
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway
| | - Jorunn Vik
- The Regional Centre for Emergency Medical Research and Development in Western Norway (RAKOS), Stavanger University Hospital, Box 8100, Stavanger, NO-4068, Norway
| | - Erik Zakariassen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Box 7804, Bergen, NO-5020, Norway
| | - Ingrid Hjulstad Johansen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Box 22, Bergen, NO-5838, Norway
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Martin LJ, Kühlmann-Berenzon S, Azerkan F, Bjelkmar P. Comparing healthcare needs by language: interpreted Arabic and Somali telehealth calls in two regions of Sweden, 2014-18. Eur J Public Health 2024; 34:537-543. [PMID: 38775060 PMCID: PMC11161146 DOI: 10.1093/eurpub/ckae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Limited language fluency can impede healthcare system navigation. In Sweden, the national telehealth line (Healthcare Guide 1177) offers interpretation in Arabic and Somali. We compared calls by language to identify differences in healthcare use for immigrant populations, focusing on three contact causes: pregnancy; vomiting or nausea in children; and worry/anxiety. METHODS We conducted a cross-sectional analysis of 3.9 million (n = 18 351 Arabic, n = 7199 Somali) telehealth calls (2014-18). Using multivariable logistic regression, we investigated associations between language of the call (Arabic, Somali, non-interpreted) and each contact cause. Potential confounders (age, region, year, and additionally for vomiting or nausea, month) and an interaction between age and language were considered. RESULTS Compared with non-interpreted calls, interpreted calls were associated with increased odds of being for pregnancy, especially for 19 to 29-year-olds [adjusted odds ratio (aOR) (95% CI) = 4.04 (3.66-4.46) and 4.60 (4.05-5.23), for Arabic and Somali calls, respectively]. Vomiting or nausea showed similar results, with aOR increasing with age: from 0.90 (0.75-1.07) (Arabic, <1 year) to 3.79 (2.86-5.01) (Somali, 5-9 years). In contrast, in unadjusted analyses, Arabic and Somali calls were associated with decreased odds of being for worry/anxiety [OR = 0.47 (0.38-0.58) and 0.34 (0.21-0.50)], respectively, compared with non-interpreted calls. CONCLUSION Our results suggest callers to the interpreted lines may need additional assistance navigating the healthcare system for pregnancy and for vomiting or nausea among children. These findings can inform healthcare services planning for immigrants to Sweden and highlight a novel use of telehealth data as a way to uncover disparities in healthcare use within a multi-linguistic population.
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Al-Shroby WA, Sohaibani IS, AlShlash NK, Alsalamah NA, Alhraiwila NJ. Factors influencing telehealth awareness, utilization, and satisfaction in KSA: A national population-based study. J Taibah Univ Med Sci 2024; 19:677-686. [PMID: 38860261 PMCID: PMC11163165 DOI: 10.1016/j.jtumed.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 03/19/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Background Telehealth involves delivering healthcare remotely through digital platforms such as telephone and video calls. Use of telehealth surged during the COVID-19 pandemic because of the need for contactless healthcare. The Saudi Ministry of Health established the "937 telephone medical consultation call center" almost 10 years ago. Objectives The aim of this study was to examine public awareness of, utilization of, and satisfaction with the 937 call center service, and to assess associated factors. Materials and methods This national community-based, cross-sectional study was conducted through multistage sampling with proportional allocation from 20 health directorates. Participants were selected from the general population in public places and were interviewed with a validated questionnaire. Results Of 7951 approached individuals, 7692 agreed to participate (response rate 96.7%). Seventy-eight percent of participants were aware of the 937 service, and 56.4% had previously used the service. Most (86%) users were satisfied with the service. Long waiting times were the most frequent reason (46.6%) for dissatisfaction. In multivariable analysis, service awareness and utilization were both significantly associated with having higher education (aOR 4.03, 95%CI: 3.17-5.12 and aOR 3.42, 95%CI: 2.64-4.42, respectively). Positive impressions of telephone medical consultation services, Saudi nationality, having children, having medical insurance, and having a history of chronic disease were significantly associated with awareness of, utilization of, and satisfaction with the service. Conclusion The study revealed high awareness of, utilization of, and satisfaction with the 937 telephone medical consultation call center, thus suggesting increased public acceptance of the service. Moreover, the study identified socio-demographic factors influencing public awareness of, utilization of, and satisfaction with telehealth. Further studies are required to increase understanding of the facilitators of, and barriers to, the use of service among various population groups.
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Affiliation(s)
- Walid A.A. Al-Shroby
- Deputyship of Public Health, Ministry of Health, KSA
- Public Health & Community Medicine Department, Faculty of Medicine, Beni-Suef University, Egypt
| | | | - Nora K. AlShlash
- Assistant Deputyship for Preventive Health, Ministry of Health, KSA
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Midtbø V, Fotland SLS, Johansen IH, Hunskaar S. From direct attendance to telephone triage in an emergency primary healthcare service: an observational study. BMJ Open 2022; 12:e054046. [PMID: 35501086 PMCID: PMC9062791 DOI: 10.1136/bmjopen-2021-054046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe how an intervention to limit direct attendance in an emergency primary healthcare service affected the contacts to the clinic and the level of care given, and which factors were associated with a change from direct attendance to telephone contact. DESIGN Observational study. SETTING Seven Norwegian emergency primary healthcare services. The telephone triage operators are primarily registered nurses. PARTICIPANTS Registered patient contacts to the services during 2007-2019. INTERVENTIONS In 2013, one of the seven services made an intervention to limit direct attendances to the emergency primary healthcare clinic. Through an advertisement in a local newspaper, the public was encouraged to call in advance. Patients who still attended directly, were encouraged to call in advance next time. MEASURES We compared the proportions of direct attendance and telephone contact, and of consultation by a general practitioner and telephone consultation by an operator, before and after the intervention. We also compared the proportions of direct attendance regarding gender, age group, time of day and urgency level. Descriptive analyses and log binomial regression analyses were applied. RESULTS There were 1 105 019 contacts to the seven services during the study period. The average proportion of direct attendance decreased from 68.7% (95% CI 68.4% to 68.9%) to 23.4% (95% CI 23.2% to 23.6%) in the service that carried out the intervention. Telephone consultation by an operator increased from 11.7% (95% CI 11.5% to 11.8%) to 29.2% (95% CI 28.9% to 29.5%) and medical consultation by a general practitioner decreased from 78.3% (95% CI 78.1% to 78.5%) to 57.0% (95% CI 56.7% to 57.3%). The youngest and the oldest age group and women had the largest decrease in direct attendance, by -81%, -74% and -71%, respectively. CONCLUSION The intervention influenced how the public contacted the service. Information campaigns on how to contact healthcare services should be implemented on a regular basis.
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Affiliation(s)
- Vivian Midtbø
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Siri-Linn Schmidt Fotland
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | | | - Steinar Hunskaar
- NORCE Health, NORCE Norwegian Research Centre AS, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
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Lindberg BH, Rebnord IK, Høye S. Phone triage nurses' assessment of respiratory tract infections - the tightrope walk between gatekeeping and service providing. A qualitative study. Scand J Prim Health Care 2021; 39:139-147. [PMID: 33792485 PMCID: PMC8293966 DOI: 10.1080/02813432.2021.1908715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Phone nurses triage callers to Norwegian out-of-hours cooperatives to estimate the appropriate urgency and level of care for the caller. Many callers with mild symptoms of respiratory tract infections receive a doctor's consultation, which may lead to busy sessions and in turn impair clinical decisions. OBJECTIVE This study explores how phone triage nurses assess callers with mild-to-moderate symptoms of respiratory tract infections and their views and experiences on triaging and counselling these callers. METHODS We conducted four focus groups with 22 nurses (five men and 17 women aged 24-66 years) in three different locations in Norway. The interviews were transcribed verbatim and analysed by systematic text condensation. RESULTS The informants were reluctant to call themselves gatekeepers. However, their description of their work indicates that they practice such a role. When nurses and callers disagreed about the right level of care, the informants sought consensus through strategies and negotiations. The informants described external factors such as organisational or financial issues as decisive for the population's use of out-of-hours services. They also described callers' characteristics, such as language deficiency and poor ability to describe symptoms, as determining their own clinical assessments. CONCLUSIONS Nurses perceive assessments of callers with respiratory tract infections as challenging. They need skills and time to reach a consensus with the callers and guide them to the right level of health care. This should be considered when planning nurse training and staffing of out-of-hours cooperatives.KEY-POINTSPhone triage nurses assess callers to the out-of-hours service and estimate the level of urgencyThis study explores how phone triage nurses assess callers with respiratory tract infections and their views and experiences on this taskThe nurses describe their professional role as a tightrope walk between gatekeeping and service providingThe nurses seek consensus with callers through strategies and negotiations.
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Affiliation(s)
- Bent Håkan Lindberg
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sigurd Høye
- Antibiotic Centre for Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Rysst Gustafsson S, Eriksson I. Quality indicators in telephone nursing - An integrative review. Nurs Open 2020; 8:1301-1313. [PMID: 33369230 PMCID: PMC8046143 DOI: 10.1002/nop2.747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
Aim The aim of this study was to identify factors that indicate quality in telephone nursing. Design An integrative literature review. Method A literature search was performed in October 2018, in the PubMed, CINAHL, Cochrane Library, Academic Search, PsycINFO, Scopus and Web of Science databases. A total of 30 included were included and data that corresponded to the study's aim were extracted and categorized along the three areas of quality as described by Donabedian (Milbank Quarterly, 83, 691), namely structure, process and outcome. Results The analysis revealed ten factors indicating quality in telephone nursing (TN): availability and simplicity of the service, sustainable working conditions, specialist education and TN experience, healthcare resources and organization, good communication, person‐centredness, competence, correct and safe care, efficiency and satisfaction. TN services need to target all ten factors to ensure that the care given is of high quality and able to meet today's requirements for the service.
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Affiliation(s)
- Silje Rysst Gustafsson
- Division of nursing and medical technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Irene Eriksson
- School of Health Sciences, University of Skövde, Skövde, Sweden
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Jácome M, Rego N, Veiga P. Potential of a nurse telephone triage line to direct elderly to appropriate health care settings. J Nurs Manag 2019; 27:1275-1284. [PMID: 31145491 DOI: 10.1111/jonm.12809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/24/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
Abstract
AIM To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care. BACKGROUND Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. METHODS Cross-sectional descriptive analysis. RESULTS Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. CONCLUSIONS The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. IMPLICATIONS FOR NURSING MANAGEMENT Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.
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Affiliation(s)
- Marta Jácome
- Unidade de Saúde Familiar Bracara Augusta, Braga, Portugal
| | - Nazaré Rego
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,INESC TEC, Porto, Portugal
| | - Paula Veiga
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,GovJus, Universidade do Minho, Braga, Portugal
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Blakoe M, Gamst-Jensen H, von Euler-Chelpin M, Collatz Christensen H, Møller T. Sociodemographic and health-related determinants for making repeated calls to a medical helpline: a prospective cohort study. BMJ Open 2019; 9:e030173. [PMID: 31482858 PMCID: PMC6720138 DOI: 10.1136/bmjopen-2019-030173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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 identify sociodemographic and health-related characteristics of callers' making repeated calls within 48 hours to a medical helpline, compared with those who only call once. SETTING In the Capital Region of Denmark people with acute, non-life-threatening illnesses or injuries are triaged through a single-tier medical helpline for acute, healthcare services. PARTICIPANTS People who called the medical helpline between 18 January and 9 February 2017 were invited to participate in the survey. During the period, 38 787 calls were handled and 12 902 agreed to participate. Calls were excluded because of the temporary civil registration number (n=78), the call was not made by the patient or a close relative (n=699), or survey responses were incomplete (n=19). Hence, the analysis included 12 106 calls, representing 11.131 callers' making single calls and 464 callers' making two or more calls within 48 hours. Callers' data (age, sex and caller identification) were collected from the medical helpline's electronic records. Data were enriched using the callers' self-rated health, self-evaluated degree of worry, and registry data on income, ethnicity and comorbidities. The OR for making repeated calls was calculated in a crude, sex-adjusted and age-adjusted analysis and in a mutually adjusted analysis. RESULTS The crude logistic regression analysis showed that age, self-rated health, self-evaluated degree of worry, income, ethnicity and comorbidities were significantly associated with making repeated calls. In the mutually adjusted analysis associations decreased, however, odds ratios remained significantly decreased for callers with a household income in the middle (OR=0.71;95% CI 0.54 to 0.92) or highest (OR=0.68;95% CI 0.48 to 0.96) quartiles, whereas immigrants had borderline significantly increased OR (OR=1.34;95% CI 0.96 to 1.86) for making repeated calls. CONCLUSIONS Findings suggest that income and ethnicity are potential determinants of callers' need to make additional calls within 48 hours to a medical helpline with triage function.
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Affiliation(s)
- Mitti Blakoe
- Emergency Medical Services Copenhagen, Emergency Medical Services Copenhagen, Ballerup, Denmark
- University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Hejdi Gamst-Jensen
- Emergency Medical Services Copenhagen, Emergency Medical Services Copenhagen, Ballerup, Denmark
| | - My von Euler-Chelpin
- Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | | | - Tom Møller
- University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- The University Hospitals Centre for Health Research, Copenhagen, Denmark
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Ericsson M, Ängerud KH, Brännström M, Lawesson SS, Strömberg A, Thylén I. Interaction between tele-nurses and callers with an evolving myocardial infarction: Consequences for level of directed care. Eur J Cardiovasc Nurs 2019; 18:545-553. [PMID: 31067981 DOI: 10.1177/1474515119848195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rapid contact with emergency medical services is imperative to save the lives of acute myocardial infarction patients. However, many patients turn to a telehealth advisory nurse instead, where the delivery of urgent and safe care largely depends on how the interaction in the call is established. PURPOSE The purpose of this study was to explore the interaction between tele-nurses and callers with an evolving myocardial infarction after contacting a national telehealth advisory service number as their first medical contact. METHOD Twenty men and 10 women (aged 46-89 years) were included. Authentic calls were analysed using inductive content analysis. FINDINGS One overall category, Movement towards directed level of care, labelled the whole interaction between the tele-nurse and the caller. Four categories conceptualised the different interactions: a distinct, reasoning, indecisive or irrational interaction. The interactions described how tele-nurses and callers assessed and elaborated on symptoms, context and actions. The interaction was pivotal for progress in the dialogue and affected the achievement of mutual understanding in the communicative process. An indecisive or irrational interaction could increase the risk of failing to recommend or call for acute care. CONCLUSION The interaction in the communication could either lead or mislead the level of care directed in the call. This study adds new perspectives to the communicative process in the acute setting in order to identify a myocardial infarction and the level of urgency from both individuals experiencing myocardial infarction and professionals in the health system.
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Affiliation(s)
- Maria Ericsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin H Ängerud
- Heart Centre, Umeå University, Sweden.,Department of Nursing, Umeå University, Sweden
| | | | - Sofia S Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Strömberg
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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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: 18] [Impact Index Per Article: 2.6] [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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Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health 2017; 22:342-75. [PMID: 27128779 DOI: 10.1089/tmj.2016.0045] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. MATERIALS AND METHODS The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. RESULTS The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. CONCLUSIONS Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
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Affiliation(s)
- Rashid L Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Joel D Howell
- 2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,3 Department of History and Health Management and Policy, University of Michigan , Ann Arbor, Michigan
| | | | - Kathryn M Harms
- 5 Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Charles R Doarn
- 6 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio
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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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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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Gibson A, Randall D, Tran DT, Byrne M, Lawler A, Havard A, Robinson M, Jorm LR. Emergency Department Attendance after Telephone Triage: A Population-Based Data Linkage Study. Health Serv Res 2017; 53:1137-1162. [PMID: 28369871 DOI: 10.1111/1475-6773.12692] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. DATA SOURCES/COLLECTION METHODS In New South Wales (NSW), Australia, 2009-2012, all (1.04 million) calls to a telephone triage service, ED presentations, hospital admissions and death registrations, linked using probabilistic data linkage. STUDY DESIGN Population-based, observational cohort study measuring ED presentations within 24 hours of a call in patients (1) with dispositions to attend ED (compliance) and (2) low-urgency dispositions (self-referral), triage categories on ED presentation. PRINCIPAL FINDINGS A total of 66.5 percent of patients were compliant with dispositions to attend an ED. A total of 6.2 percent of patients with low-urgency dispositions self-referred to the ED within 24 hours. After age adjustment, healthdirect compliant patients were significantly less likely (7.8 percent) to receive the least urgent ED triage category compared to the general NSW ED population (16.9 percent). CONCLUSIONS This large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service and details the predictors of ED attendance. Patients who attend an ED compliant with a healthdirect helpline disposition are significantly less likely than the general ED population to receive the lowest urgency triage category on arrival.
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Affiliation(s)
- Amy Gibson
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Duong T Tran
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Mary Byrne
- Healthdirect Australia, Sydney, NSW, Australia
| | - Anthony Lawler
- Department of Health and Human Services, University of Tasmania and Healthdirect Australia, Hobart, Tasmania, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Maureen Robinson
- Healthdirect Australia, Clinical Governance, Sydney, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
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Johnson C, Wilhelmsson S, Börjeson S, Lindberg M. Improvement of communication and interpersonal competence in telenursing - development of a self-assessment tool. J Clin Nurs 2014; 24:1489-501. [DOI: 10.1111/jocn.12705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Christina Johnson
- Medical Advisory Service and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Susan Wilhelmsson
- Research & Development Unit in Local Health Care, and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Sussanne Börjeson
- Division of Nursing; Department of Oncology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Malou Lindberg
- Medical Advisory Service and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Ernesäter A, Engström M, Winblad U, Holmström IK. A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish healthcare direct: a case-control study. BMJ Open 2014; 4:e005961. [PMID: 25280808 PMCID: PMC4187455 DOI: 10.1136/bmjopen-2014-005961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. SETTING In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. PARTICIPANTS A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. RESULTS Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. CONCLUSIONS The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems.
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Affiliation(s)
- Annica Ernesäter
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, Caring Science University of Gavle, Gavle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
| | - Inger K Holmström
- Department of Public Health and Caring Sciences, Uppsala University, Health Services Research, Uppsala, Sweden
- Mälardalen University School of Health, Care and Social Welfare, Vasteras, Sweden
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Parahoo K. Interviews. Nurs Res 2014. [DOI: 10.1007/978-1-137-28127-2_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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LaVela SL, Gering J, Schectman G, Locatelli SM, Weaver FM, Davies M. Improving the quality of telephone-delivered health care: a national quality improvement transformation initiative. Fam Pract 2013; 30:533-40. [PMID: 23689516 DOI: 10.1093/fampra/cmt020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many Veterans Affairs (VA) primary care (PC) patients prefer telephone-delivered care to other health care delivery modalities. OBJECTIVE To evaluate PC patients' telephone experiences and outcomes before and after a national telephone transformation quality improvement (QI) collaborative. METHODS Cross-sectional surveys were conducted pre- and post-collaborative. We used bivariate analyses to assess differences in pre/post outcomes and multivariate regression to identify variables associated with patients' perceptions of poor quality care. RESULTS Patients from 13 VA facilities participated (n = 730; pre-intervention = 314, post-intervention = 416); most of them were males (90%) with a mean age of 62 years. After the collaborative (versus pre-collaborative), few experienced transfers (52% versus 62%, P = 0.0006) and most reported timely call answer (88% versus 80%, P = 0.003). Improvements in staff understanding why patients were calling and providing needed medical information were also found. There were measurable improvements in patient satisfaction (87% versus 82% very/mostly satisfied, P = 0.04) and perceived quality of telephone care (85% versus 78% excellent/good quality, P = 0.01) post- collaborative. The proportion of veterans who reported delayed care due to telephone access issues decreased from 41% to 15% after the collaborative, P < 0.0001. Perceptions of poor quality care were higher when calls were for urgent care needs did not result in receipt of needed information and included a transfer or untimely answer. CONCLUSIONS The QI collaborative led to improvements in timeliness of answering calls, patient satisfaction and perceptions of high-quality telephone care and fewer reports of health care delays. Barriers to optimal telephone care 'quality' include untimely answer, transfers, non-receipt of needed information and urgent care needs.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL
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Ernesäter A, Winblad U, Engström M, Holmström IK. Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why? J Telemed Telecare 2012; 18:379-83. [DOI: 10.1258/jtt.2012.120416] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003–2010 ( n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller ( n = 12) was the most common reason for malpractice claims, and work-group discussion ( n = 13) was the most common measure taken to prevent future re-occurrence. Male patients ( n = 19) were in the majority, and females ( n = 24) were the most common callers. The most common symptoms were abdominal ( n = 11) and chest pain ( n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.
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Affiliation(s)
- Annica Ernesäter
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
- Faculty of Health and Occupational Studies, University of Gävle, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Maria Engström
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
- Faculty of Health and Occupational Studies, University of Gävle, Sweden
| | - Inger K Holmström
- Department of Public Health and Caring Sciences, Uppsala University, Sweden
- School of Health and Medicine, Örebro University, Sweden
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