Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial

Abstract

Objective To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices. Design Pragmatic, randomised controlled trial. Setting Four general practices in England. Participants 278 adults who had not been reviewed in the previous 11 months. Intervention Participants were randomised to either telephone review or face to face consultation with the asthma nurse. Main outcome measures Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated "short Q" asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation. Results Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P < 0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference − 0.07 (95% confidence interval − 0.40 to 0.27) or in satisfaction with the consultation (risk difference − 0.07 ( − 0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P < 0.001)). Conclusions Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma.

Pragmatic Trials

“…Telephone consultations have been shown in a randomised controlled trial to achieve higher rates of participation in routine asthma reviews than the traditional method of face-to-face reviews. 149 But a large proportion of patients declined to take part in the trial, calling into question the generalisability of the findings to routine practice. In a subsequent implementation study, 150 Pinnock and colleagues compared three forms of asthma review service: a structured recall system in which patients were contacted up to three times by post or by memo issued with repeat prescriptions, and offered the choice of a telephone or a face-to-face review, then followed up opportunistically if they did not make an appointment; a similar recall system (but with no opportunistic follow-up) in which patients were offered only a face-to-face review; and usual care, in which there was no systematic recall.…”

Telephone or surgery asthma reviews? Preferences of participants in a primary care randomised controlled trial

“…Only about a third of people with asthma heed this advice and attend their general practice for a routine annual review [3,4]. Our trial of telephone consultations for asthma demonstrated that telephone-based care can facilitate delivery of routine healthcare, substantially increasing the proportion of patients reviewed when compared with traditional faceto-face consultations [5]. We aimed to explore the preferences expressed by people with asthma for alternative modes of consultation in order to gain insight into factors which may influence the …”

Professional and patient attitudes to using mobile phone technology to monitor asthma: questionnaire survey

“…Modern forms of communication offer considerable potential for enhancing medical care [1][2][3], particularly in ensuring timely access to emergency advice [4,5], and in the management of chronic disease [6,7]. Mobile phones are now widely available [8], and offer innovative opportunities for messaging which have been used to remind patients of appointments [9] and to encourage compliance with inhaled steroids in asthma [10].…”