This post discusses the review “Telephone consultation and triage: effects on health care use and patient satisfaction”
Let us review what the key terms mean:
Telephone consultation: The process where calls are received, assessed and managed by giving advice, or by referral to a more appropriate service. The calls may be received by a doctor, nurse, or other health professional.
Triage: The process of determining the priority of patients’ treatment based on the severity of their condition
What was the (research) questions the reviewers were trying to answer? What are the effects of telephone consultation on safety, service usage and patient satisfaction? How do these compare between different types of health professionals providing this service?
What did the reviewers do? They searched for Randomized Controlled Trials (RCTs), Controlled Clinical Trials (CCTs), and Interrupted Time Series (ITSs) of telephone consultation in general health care settings. Only nine studies met the criteria for inclusion in the review. The rest of the procedure was similar to that described in previous posts.
What did they find? In general, at least half (50%) of the calls were handled by telephone only (there was no face-to-face consultation). Of the seven studies that looked at Accident and Emergency Department (Casualty) visits, six found no increase in visits, while one reported an increase. Patient satisfaction was comparable to a face-to-face consultation. It is not known whether visits to Accident and Emergency Department (Casualty) were merely delayed by the telephone consultation.
How does one explain these findings?
We need to consider the following:
1. Disease specific phone lines were excluded from this review. Therefore, the findings cannot be extended/ extrapolated (generalized) to all telephone consultations.
2. Two of five studies found an increase in return consultation, while the other three reported a decrease in visits to General Practitioners. It is entirely possible that in many instances of return telephone consultation, a single face-to-face visit might have been sufficient (physical examination would yield more accurate clues to the condition).
3. Safety was assessed in seven studies by looking at visits to the Accident and Emergency Department (Casualty). Of these, six reported no increase in visits during the study period. However, there could have been increased visits outside the study period. In addition, the nature of call would influence whether a visit to the Accident and Emergency Department was necessary. Simple queries, or those dealing with minor conditions would not require such visits. On the other hand, those facing a serious condition would probably go to the Accident and Emergency Department directly, without wasting time on a telephone consultation.
4. Satisfaction levels are unlikely to be affected if the call was made for a relatively minor condition.
Bottomline: Telephone consultation in a general health care setting appears to be safe. However, further research into its effectiveness, cost, and safety is required