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Vainio H, Soininen L, Castrén M, Torkki P. Identifying performance indicators to measure overall performance of telephone triage - a scoping review. Scand J Prim Health Care 2024; 42:38-50. [PMID: 38078730 PMCID: PMC10851803 DOI: 10.1080/02813432.2023.2283188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/08/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This article aims to summarize performance indicators used in telephone triage services research, and make recommendations for the selection of valid indicators to measure the performance of telephone triage. We describe what kind of frameworks, performance indicators, or variables have been used for evaluating telephone triage performance by systematically mapping the telephone triage performance measurement. The objective was to find measures for each Triple Aim dimension. DESIGN A scoping review method was used following Joanna Briggs Institute guidelines. Using this method, we defined indicators to measure the performance of telephone triage. We used the Triple Aim framework to identify indicators to measure the overall performance of telephone triage. The Triple Aim framework consists of improving the patient experience of care, improving the health of populations, and reducing cost per capita. SETTING The scoping review was performed using CINAHL, Medline, EBSCOhost, and PubMed electronic databases. The eligibility criterion was research published in English between 2015 and 2023. The inclusion focused on the use and performance of telephone triage services and system-focused studies. RESULTS A total of 1098 papers were screened for inclusion, with 57 papers included in our review. We identified 13 performance indicators covering all Triple Aim dimensions: waiting times, access, patient satisfaction, the accuracy of triage decision, severity and urgency of the symptoms, triage response, patient compliance with the advice given, follow-up healthcare service use, and running costs of service. We didn't find any earlier framework covering all Triple Aim dimensions properly. CONCLUSIONS Measuring the performance of telephone triage requires an extensive and comprehensive approach. We presented performance indicators that may be included in the framework for measuring the performance of telephone triage to support overall performance measurements of telephone triage.
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Affiliation(s)
- Hanna Vainio
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Leena Soininen
- DigiFinland Ltd., University of Helsinki, Helsinki, Finland
| | - Maaret Castrén
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Chair SY, Chien WT, Kendall S, Zang Y, Liu T, Choi KC. Effects of Telephone Consultation on Safety, Service Use, Patient Satisfaction, and Workload: Systematic Review and Meta-Analysis of Randomized Trials. Telemed J E Health 2024; 30:364-380. [PMID: 37624630 DOI: 10.1089/tmj.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Objective: Telephone consultation (TC) is widely used for its easy access and convenience. This review aimed to assess the effects of TC including triage on safety, service use, patient satisfaction, and health professionals' workload to inform directions for future health service practice. Methods: CENTRAL, MEDLINE, Embase, CINAHL, ProQuest Dissertation & Theses (Health & Medicine), ClinincalTrials.gov, and International Clinical Trial Registry Platform were searched on April 7, 2022. The included were randomized controlled trials that compared TC with standard (face-to-face [F2F]) management or that by another group of call advisers. Cochrane methods were used to select eligible studies, assess the risk of bias, estimate summary effect measure, and grade evidence certainty. Meta-analysis was performed on important outcomes with moderate- or high-quality evidence. Results: Eight studies were included involving 40,002 participants. TC could increase call resolution-proportion of callers' concerns being addressed by telephone advice alone (two studies; high certainty) and reduce F2F contacts with doctors for the first consultation (two studies, moderate certainty) compared with standard management or TC by doctors. None of included studies reported increases in adverse events, including all-cause mortality, acute and emergency department visit, and hospitalization. There was inadequate evidence regarding the effects of TC on patient satisfaction and length of consultation. Conclusion: The findings support the benefits of TC on improving call resolution and reducing F2F contacts with doctors on the day of first management for regular day service; and TC by nurses can provide better effects than that by doctors for out-of-hours service.
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Affiliation(s)
- Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Sally Kendall
- Community Nursing and Public Health, Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Yuli Zang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Ting Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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Lubomski J, Malchrzak W, Babicki M, Kłoda K, Suwała S, Mastalerz-Migas A. Teleconsultation as a Modern Form of Health Care Service in the Case of Poland: Assessment of Its Potential Use from the Perspective of Health Care Providers and Patients. Telemed J E Health 2024; 30:234-241. [PMID: 37406293 DOI: 10.1089/tmj.2023.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has facilitated access to health care services through telemedicine in Poland, where it has not been a common approach so far. Therefore, the aim of this study was to evaluate telemedicine as a form of health care provision in the Polish health care system. Methods: An online questionnaire was distributed to 2,318 patients and health care workers. Questions included telemedical services usage, attitude toward telemedical consultations, who should decide about the nature of the consultation, advantages and disadvantages of telemedicine, the possibility of teleconsultations remaining available after the pandemic, and the subjective perception of overuse of remote consultations by doctors. Results: In general, respondents approved of teleconsultations (3.62 on 1-5 scale) but specific clinical situations gained higher and lower scores-among the highest ranking were prescription renewal (4.68), interpretation of examination results (4.15), and treatment continuation/follow-up (3.81). Among least ranking were consulting children 2-6 years old (1.93) and children younger than 2 years old (1.55) as well as consulting acute symptoms (1.47). Health care workers rated their general attitude significantly higher than nonhealth care workers toward telemedicine consults (3.91 vs. 3.34, p < 0.001) and toward 12 out of 13 specific clinical situations and settings (p < 0.001). The only exception was "consulting acute symptoms," which received exactly the same rating within both groups (1.47, p = 0.99). Most respondents agreed that teleconsultations should remain an option for contacting a physician regardless of the epidemic situation. Each group declared that they should be the one to decide about the consultation form. Conclusions: Results of this study could help optimize and facilitate telemedical consultation usage after the COVID-19 pandemic.
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Affiliation(s)
- Jan Lubomski
- Ma-na-ma Huisartsgeneeskunde, KU Leuven, Belgium
| | - Wojciech Malchrzak
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Szymon Suwała
- Department of Endocrinology and Diabetology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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Trankle SA, Reath J. Afterhours telehealth in Australian residential aged care facilities: a mixed methods evaluation. BMC Health Serv Res 2023; 23:1263. [PMID: 37968685 PMCID: PMC10652444 DOI: 10.1186/s12913-023-10257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 10/31/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. METHODS Using the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents. RESULTS Most calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications. CONCLUSIONS The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.
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Affiliation(s)
- Steven A Trankle
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jennifer Reath
- Department of General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Laake JP, De Soysa M, Subhaskaran K, Scott J, Baker ISC, Alavala S, Desai D, Hein J, Owen K. Impact of Increased Patient-Clinician Virtual Visits During the COVID-19 Pandemic on Medical Student Enthusiasm for Future General Practice Careers. Fam Med 2023; 55:3-11. [PMID: 36656881 PMCID: PMC10681335 DOI: 10.22454/fammed.55.909451] [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: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic restricted the availability of face-to-face primary care visits. This rapidly increased the proportion of primary care patient-clinician visits conducted virtually and asynchronously (remote consultations via video, telephone, and web-based text/email), altering the educational environment for medical students. Our study explored the impact of the increased proportion of primary care visits conducted virtually and asynchronously, on medical students' self-reported interest in pursuing a career in general (family) practice. METHODS We conducted a cross-sectional survey study of medical students at six universities within England and Wales to explore the impact of the increased proportion of primary care visits conducted virtually and asynchronously on medical students' interest in pursuing a career in general practice. RESULTS One hundred fifty-four medical students were recruited between December 2020 and May 2021; 79 (51%) of the participants reported being less interested in pursuing a career in general practice as a result of the increased proportion of virtual and asynchronous primary care visits during the COVID-19 pandemic. This increased to 104 (68%) of the participants reporting being less interested should primary care visits continue to be delivered virtually or asynchronously by default. Analysis of open-ended survey questions identified a poorer educational experience, concerns regarding the impact on patient care, an isolated working environment and technological challenges as key negative themes. CONCLUSIONS Sociable, supportive working and learning environments and offering equitable care are important motivators for the future workforce. There is a need to develop robust training and assessment in patient-clinician virtual visits and asynchronous communication and to integrate this into curricula.
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Affiliation(s)
- Jean-Pierre Laake
- Warwick Medical School, University of WarwickCoventryUK
- College of Life Sciences, University of LeicesterLeicesterUK
| | | | | | - Jessica Scott
- GKT School of Medical Education, King's College LondonLondonUK
| | | | | | - Deep Desai
- Birmingham Medical School, University of BirminghamBirminghamUK
| | - Jennifer Hein
- Swansea University Medical School, Swansea UniversitySwanseaUK
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Rebolho RC, Raupp FM. Implementation costs of telephone nurse triage service. CAD SAUDE PUBLICA 2023; 39:e00095522. [PMID: 37075414 DOI: 10.1590/0102-311xen095522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 01/25/2023] [Indexed: 04/21/2023] Open
Abstract
Telephone nurse triage services are becoming increasingly common in healthcare systems worldwide. Florianópolis (Santa Catarina State, Brazil) is the first municipality in the country to provide this service in its public health system. This study adopted a quantitative, descriptive, and analytical methodology to evaluate the impact of this program on overall costs of the public health system. The research examined all 33,869 calls received by the telephone triage service from March 16 to October 31 in 2020, and calculated the program costs during the period. Avoided cost were calculated by the difference between estimated consultation costs considering patient-stated first alternative and the program recommendation after triage. Analyzing only the costs for the municipality of Florianópolis, the program's costs exceeded avoided costs by almost BRL 2.5 million during the period. By expanding the analysis to include costs of emergency department consultation - not administered by the municipality - based on data from previous research, we found that the program spares BRL 34.59 per call, a 21% cost reduction for the health system. Considering the preliminary results of the study and its limitations, it is understood that the service of telephone nurse triage can reduce costs in the healthcare system.
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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Silva CRDV, Lopes RH, de Goes Bay O, Martiniano CS, Fuentealba-Torres M, Arcêncio RA, Lapão LV, Dias S, Uchoa SADC. Digital health opportunities to improve Primary Health Care in the context of COVID-19: A Scoping Review (Preprint). JMIR Hum Factors 2021; 9:e35380. [PMID: 35319466 PMCID: PMC9159467 DOI: 10.2196/35380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/11/2022] [Accepted: 03/21/2022] [Indexed: 01/23/2023] Open
Abstract
Background The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service.
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Affiliation(s)
| | - Rayssa Horácio Lopes
- Department of Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Osvaldo de Goes Bay
- Faculty of Health Sciences, Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | | | | - Ricardo Alexandre Arcêncio
- Department of Maternal Infant Nursing and Public Health, University of São Paulo, Ribeirão Preto, Brazil
| | - Luís Velez Lapão
- Instituto de Higiene e Medicina Tropical, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
- Unidade de Investigação e Desenvolvimento em Engenharia Mecanica e Industrial, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sonia Dias
- Escola Nacional de Saúde Pública, Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisboa, Portugal
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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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Connolly SL, Gifford AL, Miller CJ, Bauer MS, Lehmann LS, Charness ME. Provider Perceptions of Virtual Care During the Coronavirus Disease 2019 Pandemic: A Multispecialty Survey Study. Med Care 2021; 59:646-652. [PMID: 34009880 PMCID: PMC8191369 DOI: 10.1097/mlr.0000000000001562] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to a dramatic increase in virtual care (VC) across outpatient specialties, but little is known regarding provider acceptance of VC. OBJECTIVE The objective of this study was to assess provider perceptions of the quality, efficiency, and challenges of VC versus in-person care with masks. DESIGN This was a voluntary survey. PARTICIPANTS Mental health (MH), primary care, medical specialty, and surgical specialty providers across the 8 VA New England Healthcare System medical centers. MEASURES Provider ratings of: (1) quality and efficiency of VC (phone and video telehealth) compared with in-person care with masks; (2) challenges of VC; and (3) percentage of patients that providers are comfortable seeing via VC in the future. RESULTS The sample included 998 respondents (49.8% MH, 20.6% primary care, 20.4% medical specialty, 9.1% surgical specialty; 61% response rate). Most providers rated VC as equivalent to or higher in quality and efficiency compared with in-person care with masks. Quality ratings were significantly higher for video versus phone (χ2=61.4, P<0.0001), but efficiency ratings did not differ significantly. Ratings varied across specialties (highest in MH, lowest in SS; all χ2s>24.1, Ps<0.001). Inability to conduct a physical examination and patient technical difficulties were significant challenges. MH providers were comfortable seeing a larger proportion of patients virtually compared with the other specialties (all χ2s>12.2, Ps<0.01). CONCLUSIONS Broad provider support for VC was stratified across specialties, with the highest ratings in MH and lowest ratings in SS. Findings will inform the improvement of VC processes and the planning of health care delivery during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Allen L. Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Boston University School of Medicine
- Boston University School of Public Health, Boston
| | - Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Mark S. Bauer
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System
- Harvard Medical School
| | - Lisa S. Lehmann
- Harvard Medical School
- VA New England Healthcare System, Bedford
| | - Michael E. Charness
- Harvard Medical School
- Boston University School of Medicine
- VA Boston Healthcare System, Boston, MA
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11
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Islam F, Sabbe M, Heeren P, Milisen K. Consistency of decision support software-integrated telephone triage and associated factors: a systematic review. BMC Med Inform Decis Mak 2021; 21:107. [PMID: 33743697 PMCID: PMC7981379 DOI: 10.1186/s12911-021-01472-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background In the recent decades, the use of computerized decision support software (CDSS)-integrated telephone triage (TT) has become an important tool for managing rising healthcare demands and overcrowding in the emergency department. Though these services have generally been shown to be effective, large gaps in the literature exist with regards to the overall quality of these systems. In the current systematic review, we aim to document the consistency of decisions that are generated in CDSS-integrated TT. Furthermore, we also seek to map those factors in the literature that have been identified to have an impact on the consistency of generated triage decisions. Methods As part of the TRANS-SENIOR international training and research network, a systematic review of the literature was conducted in November 2019. PubMed, Web of Science, CENTRAL, and the CINAHL database were searched. Quantitative articles including a CDSS component and addressing consistency of triage decisions and/or factors associated with triage decisions were eligible for inclusion in the current review. Studies exploring the use of other types of digital support systems for triage (i.e. web chat, video conferencing) were excluded. Quality appraisal of included studies were performed independently by two authors using the Methodological Index for Non-Randomized Studies. Results From a total of 1551 records that were identified, 39 full-texts were assessed for eligibility and seven studies were included in the review. All of the studies (n = 7) identified as part of our search were observational and were based on nurse-led telephone triage. Scientific efforts investigating our first aim was very limited. In total, two articles were found to investigate the consistency of decisions that are generated in CDSS-integrated TT. Research efforts were targeted largely towards the second aim of our study—all of the included articles reported factors related to the operator- (n = 6), patient- (n = 1), and/or CDSS-integrated (n = 2) characteristics to have an influence on the consistency of CDSS-integrated TT decisions. Conclusion To date, some efforts have been made to better understand how the use of CDSS-integrated TT systems may vary across settings. In general, however, the evidence-base surrounding this field of literature is largely inconclusive. Further evaluations must be prompted to better understand this area of research. Protocol registration The protocol for this study is registered in the PROSPERO database (registration number: CRD42020146323). Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01472-3.
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Affiliation(s)
- Farah Islam
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.,Department of Emergency Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Pieter Heeren
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Research Foundation Flanders, Egmontstraat 5, 1000, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium. .,Department of Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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12
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Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract 2021; 71:e166-e177. [PMID: 33558332 DOI: 10.3399/bjgp.2020.0948] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. AIM To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. DESIGN AND SETTING Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. METHOD Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. RESULTS There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. CONCLUSION The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.
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13
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Gamst-Jensen H, Frischknecht Christensen E, Lippert F, Folke F, Egerod I, Huibers L, Brabrand M, Tolstrup JS, Thygesen LC. Self-rated worry is associated with hospital admission in out-of-hours telephone triage - a prospective cohort study. Scand J Trauma Resusc Emerg Med 2020; 28:53. [PMID: 32522240 PMCID: PMC7288501 DOI: 10.1186/s13049-020-00743-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller’s subjective perception of illness severity expressed as “degree-of-worry” (DOW) and hospital admissions within 48 h. Design and setting A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service. Participants Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler. Main outcome measure Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) age-and-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted. Results A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW. Conclusion Patients’ self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.
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Affiliation(s)
- Hejdi Gamst-Jensen
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark. .,Clinical Research Centre, Amager and Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Erika Frischknecht Christensen
- Clinic of Internal and Emergency Medicine and Department of Anesthesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.,Center for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark.,Department of Cardiology, Gentofte Hospital, University of Copenhagen University Hospital, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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14
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Huibers L, Carlsen AH, Moth G, Christensen HC, Riddervold IS, Christensen MB. Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study. BMC Emerg Med 2020; 20:20. [PMID: 32183705 PMCID: PMC7079359 DOI: 10.1186/s12873-020-00312-3] [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: 05/23/2019] [Accepted: 02/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients in need of acute health care do not always contact the most suitable health care service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific health care provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. METHODS We conducted a cross-sectional observational study by sending a questionnaire to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two health care service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. RESULTS Three key motives for contacting the two service providers were identified: 'unpleasant symptoms', 'perceived need for prompt action' and 'perceived most suitable health care provider'. Other important motives were 'need arose outside office hours' and 'wanted to talk to a physician' (out-of-hours primary care) and 'expected need for ambulance' and 'worried' (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. CONCLUSIONS Patient motives for contacting the two health care service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute health care. This knowledge could help optimise existing health care services, such as patient safety and the service level, without increasing health care costs.
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Affiliation(s)
- Linda Huibers
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark.
| | - Anders H Carlsen
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Grete Moth
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Helle C Christensen
- Emergency Medical Services, Telegrafvej 5, 2750, Ballerup, Denmark.,Danish Clinical Quality Program (RKKP), Frederiksberg Hospital, Ndr. Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Ingunn S Riddervold
- Prehospital Emergency Medical Services, Central Denmark Region, Olof Palmes Allé 34, 8200, Aarhus, N, Denmark
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15
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Foster H, Moffat KR, Burns N, Gannon M, Macdonald S, O'Donnell CA. What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature. BMJ Open 2020; 10:e033481. [PMID: 31959608 PMCID: PMC7045150 DOI: 10.1136/bmjopen-2019-033481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS). DESIGN Systematic scoping review. DATA SOURCES CINAHL; Medline; PsyARTICLES; PsycINFO; SocINDEX; and Embase from 1995 to 2019. STUDY SELECTION English language studies in UK or similar international settings, focused on services in or directly impacting primary care. RESULTS 105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs. CONCLUSIONS Policy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services. PROSPERO REGISTRATION NUMBER CRD42015029741.
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Affiliation(s)
- Hamish Foster
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Keith R Moffat
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Nicola Burns
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Maria Gannon
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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16
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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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17
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Heidet M, Canoui-Poitrine F, Revaux F, Perennou T, Bertin M, Binetruy C, Palazzi J, Tapiero E, Nguyen M, Reuter PG, Lecarpentier E, Vaux J, Marty J. Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France. BMC Health Serv Res 2019; 19:531. [PMID: 31362748 PMCID: PMC6668156 DOI: 10.1186/s12913-019-4350-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient’s file after such triage and second, to analyse the factors associated with altered reporting. Methods Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. Results Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). Conclusion In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care. Electronic supplementary material The online version of this article (10.1186/s12913-019-4350-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France. .,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France.
| | - Florence Canoui-Poitrine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, Département de Santé Publique, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-7376 (Clinical Epidemiology and Ageing, CEpiA), Créteil, France
| | - François Revaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Thomas Perennou
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Maeva Bertin
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Charles Binetruy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Palazzi
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Eric Tapiero
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Michel Nguyen
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Paul-Georges Reuter
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Raymond Poincaré, SAMU 92, Garches, France
| | - Eric Lecarpentier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France
| | - Julien Vaux
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
| | - Jean Marty
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri Mondor, SAMU 94 et Urgences, Créteil, France.,Université Paris-Est Créteil (UPEC), EA-4390 (Analysis of Risk in Complex Health Systems, ARCHeS), Créteil, France
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Vilstrup E, Graversen DS, Huibers L, Christensen MB, Pedersen AF. Communicative characteristics of general practitioner-led and nurse-led telephone triage at two Danish out-of-hours services: an observational study of 200 recorded calls. BMJ Open 2019; 9:e028434. [PMID: 31230024 PMCID: PMC6596995 DOI: 10.1136/bmjopen-2018-028434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Out-of-hours (OOH) telephone triage is used to manage patient flow, but knowledge of the communicative skills of telephone triagists is limited. The aims of this study were to compare communicative parameters in general practitioner (GP)-led and nurse-led OOH telephone triage and to discuss differences in relation to patient-centred communication and safety issues. DESIGN Observational study. SETTING Two Danish OOH settings: a large-scale general practitioner cooperative in the Central Denmark Region (n=100 GP-led triage conversations) and Medical Helpline 1813 in the Capital Region of Denmark (n=100 nurse-led triage conversations with use of a clinical decision support system). PARTICIPANTS 200 audio-recorded telephone triage conversations randomly selected. PRIMARY AND SECONDARY OUTCOME MEASURES Conversations were compared with regard to length of call, distribution of speaking time, question types, callers' expression of negative affect, and nurses' and GPs' responses to callers' negative affectivity using the Mann-Whitney U test and the Student's t-test. RESULTS Compared with GPs, nurses had longer telephone contacts (137s vs 264 s, p=0.001) and asked significantly more questions (5 vs 9 questions, p=0.001). In 36% of nurse-led triage conversations, triage nurses either transferred the call to a physician or had to confer the call with a physician. Nurses gave the callers significantly more spontaneous talking time than GPs (23.4s vs 17.9 s, p=0.01). Compared with nurses, GPs seemed more likely to give an emphatic response when a caller spontaneously expressed concern; however, this difference was not statistically significant (36% vs 29%, p=0.6). CONCLUSIONS When comparing communicative parameters in GP-led and nurse-led triage, several differences were observed. However, the impact of these differences in the perspective of patient-centred communication and safety needs further research. More knowledge is needed to determine what characterises good quality in telephone triage communication.
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Affiliation(s)
- Emil Vilstrup
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Dennis Schou Graversen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Brasseur E, Servotte JC, Donneau AF, Stipulante S, d'Orio V, Ghuysen A. Triage for out-of-hours primary care calls: a reliability study of a new French-language algorithm, the SALOMON rule. Scand J Prim Health Care 2019; 37:227-232. [PMID: 31033368 PMCID: PMC6567030 DOI: 10.1080/02813432.2019.1608057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Triage systems for out-of-hours primary care physician (PCP) calls have been implemented empirically but no triage algorithm has been validated to date. A triage algorithm named SALOMON (Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne) was developed to guide triage nurses. This study assessed the performance of the algorithm using simulated PCP calls. Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON's inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2). Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p < 0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively. Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting.
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Affiliation(s)
- Edmond Brasseur
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
| | - Jean-Christophe Servotte
- Medical Simulation Center of Liege, University of Liege, Liege, Belgium;
- Public Health Sciences Department, University of Liege, Liege, Belgium;
| | | | | | - Vincent d'Orio
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
| | - Alexandre Ghuysen
- Emergency Department, University Hospital Center of Liege, Liege, Belgium;
- Medical Simulation Center of Liege, University of Liege, Liege, Belgium;
- Public Health Sciences Department, University of Liege, Liege, Belgium;
- CONTACT Alexandre Ghuysen Emergency Department, University Hospital Center of Liege, CHU de Liège, Service des urgences, Avenue Hippocrate, 13, B-4000 Liège, Belgium; Medical Simulation Center of Liege, University of Liege, Liege, Belgium; Public Health Sciences Department, University of Liege, Liege, Belgium
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Slagman A, Greiner F, Searle J, Harriss L, Thompson F, Frick J, Bolanaki M, Lindner T, Möckel M. Suitability of the German version of the Manchester Triage System to redirect emergency department patients to general practitioner care: a prospective cohort study. BMJ Open 2019; 9:e024896. [PMID: 31064804 PMCID: PMC6527986 DOI: 10.1136/bmjopen-2018-024896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the suitability of the German version of the Manchester Triage System (MTS) as a potential tool to redirect emergency department (ED) patients to general practitioner care. Such tools are currently being discussed in the context of reorganisation of emergency care in Germany. DESIGN Prospective cohort study. SETTING Single centre University Hospital Emergency Department. PARTICIPANTS Adult, non-surgical ED patients. EXPOSURE A non-urgent triage category was defined as a green or blue triage category according to the German version of the MTS. PRIMARY AND SECONDARY OUTCOME MEASURES Surrogate parameters for short-term risk (admission rate, diagnoses, length of hospital stay, admission to the intensive care unit, in-hospital and 30-day mortality) and long-term risk (1-year mortality). RESULTS A total of 1122 people presenting to the ED participated in the study. Of these, 31.9% (n=358) received a non-urgent triage category and 68.1% (n=764) were urgent. Compared with non-urgent ED presentations, those with an urgent triage category were older (median age 60 vs 56 years, p=0.001), were more likely to require hospital admission (47.8% vs 29.6%) and had higher in-hospital mortality (1.6% vs 0.8%). There was no significant difference observed between non-urgent and urgent triage categories for 30-day mortality (1.2% [n=4] vs 2.2% [n=15]; p=0.285) or for 1-year mortality (7.9% [n=26] vs 10.5% [n=72]; p=0.190). Urgency was not a significant predictor of 1-year mortality in univariate (HR=1.35; 95% CI 0.87 to 2.12; p=0.185) and multivariate regression analyses (HR=1.20; 95% CI 0.77 to 1.89; p=0.420). CONCLUSIONS The results of this study suggest the German MTS is unsuitable to safely identify patients for redirection to non-ED based GP care. TRIAL REGISTRATION NUMBER U1111-1119-7564; Post-results.
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Affiliation(s)
- Anna Slagman
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Greiner
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Julia Searle
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Linton Harriss
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
| | - Johann Frick
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
- Institute of Medical Sociology and Rehabilitation Science, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Myrto Bolanaki
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Lindner
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Möckel
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Emergency and Acute Medicine (CVK, CCM), Charite Universitätsmedizin Berlin, Berlin, Germany
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Gamst-Jensen H, Frishknecht Christensen E, Lippert F, Folke F, Egerod I, Brabrand M, Tolstrup JS, Thygesen LC, Huibers L. Impact of caller's degree-of-worry on triage response in out-of-hours telephone consultations: a randomized controlled trial. Scand J Trauma Resusc Emerg Med 2019; 27:44. [PMID: 30975160 PMCID: PMC6458647 DOI: 10.1186/s13049-019-0618-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 11/17/2022] Open
Abstract
Background Telephone triage entails assessment of urgency and direction of flow in out-of-hours (OOH) services, while visual cues are inherently lacking. Triage tools are recommended but current tools fail to provide systematic assessment of the caller’s perspective. Research demonstrated that callers can scale their degree-of-worry (DOW) in a telephone contact with OOH services, but its impact on triage response is undetermined. The aim of this study was to investigate the association between call-handlers’ awareness of the caller’s DOW and the telephone triage response. Methods A randomized controlled trial at a Danish OOH service using telephone triage with quantitative analyses and qualitative process evaluation. Prior to contact with a call-handler, callers were asked to rate their DOW on a five-point scale. Calls were randomized to show or not show DOW on the call-handlers’ screens. Triage response (telephone consultation or face-to-face consultation) was analysed using Chi-square tests. Process evaluation incorporated a quantitative and qualitative assessment of intervention implementation and fidelity. Results Of 11,413 calls, 5705 were allocated to the intervention and 5708 to the control group. No difference in number of face-to-face consultations was detected between the two groups (OR 1.05, 95% CI 0.98 to 1.14, p = 0.17). The process evaluation showed that call-handlers did not use the DOW systematically and were reluctant to use DOW. Conclusion Awareness of DOW did not affect the triage response, but this finding could reflect a weak implementation strategy. Future studies should emphasise the implementation strategy to determine the effect of DOW on triage response. Trial registration Registration number, Clinicaltrials.gov NCT02979457. Electronic supplementary material The online version of this article (10.1186/s13049-019-0618-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hejdi Gamst-Jensen
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark.
| | - Erika Frishknecht Christensen
- Center for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinic of Emergency Medicine and Department of Anaesthesiology and Intensive Care, Aalborg University Hospital South, Aalborg, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, Copenhagen University, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.,Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Keizer E, Christensen MB, Carlsen AH, Smits M, Wensing M, Senn O, Huibers L. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. BMC Public Health 2019; 19:33. [PMID: 30621741 PMCID: PMC6323727 DOI: 10.1186/s12889-018-6332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background The acute out-of-hours healthcare services are challenged by increasing demand in many countries. We aimed to examine factors influencing the intended help-seeking in out-of-hours care for acute health problems during evenings, nights, and weekends. Methods We conducted a survey study based on data from parents of children (aged 0–4 years) and adults (aged 30–39 and 50–59 years) in Denmark, the Netherlands and Switzerland. Intended help-seeking behaviour was measured by six hypothetical case scenarios. We used Andersen’s Behavioural Model to categorise potentially influential factors and applied multiple binomial regression to assess the influence of selected factors. Results A total of 1015 parents and 2942 adults participated. We identified several significant influential factors. Parents holding a low education (OR 1.56), having migrant background (western: OR 1.23; non-western: OR 1.93), having one child (OR 1.24), perceiving few barriers to using out-of-hours primary care (OR 1.59), perceiving difficulties with organising childcare (OR 1.13), and having a history of frequent contacts with out-of-hours care (OR 1.55) were more inclined to contact out-of-hours care, whereas female (OR 0.85) and non-anxious parents (OR 0.77) were less inclined. Adults who were older (OR 1.01), holding a medical education (OR 1.13), having non-western background (OR 1.28), being unemployed (OR 1.17), perceiving few barriers to using out-of-hours primary care (OR 1.37), and having a history of frequent contacts with a GP (few: OR 1.15; more: OR 1.22) and/or with out-of-hours care (one: OR 1.20; more: OR 1.49) were more inclined to contact out-of-hours care, whereas adults with no or little social support (OR 0.84) and adults with high health literacy level on health information (OR 0.91) were less inclined. Dutch parents were less inclined than Danish parents to contact out-of-hours care (OR 0.62), whereas Swiss adults were more inclined than Danish adults to contact out-of-hours care (OR 1.16). Conclusion We identified several factors related to intended help-seeking in out-of-hours care. These results could be used to develop targeted interventions, but more research is needed to examine the underlying explanations for the identified differences. Electronic supplementary material The online version of this article (10.1186/s12889-018-6332-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | | | - Anders Helles Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Linda Huibers
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
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