Delays in response and triage times reduce patient satisfaction and enablement after using out-of-hours services

Kelly, Mark; Egbunike, Jennifer Nkem; Kinnersley, Paul; Hood, Kerenza; Owen-Jones, Eleri; Button, Lori; Shaw, Christine; Porter, Alison; Snooks, Helen; Bowden, Sue; Edwards, Adrian

doi:10.1093/fampra/cmq057

Cited by 24 publications

(28 citation statements)

References 22 publications

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“…27 Generally, patients have found telephone consultations with GPs and nurses to be acceptable, 11,13,70,[73][74][75] although one systematic review included primary studies that, overall, showed patient dissatisfaction with telephone consultations. 76 Our findings are consistent with past research with respect to GPT.…”

Section: Patient Experiencementioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

Campbell

Fletcher

Britten

et al. 2015

Health Technology Assessment

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BackgroundTelephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice.ObjectivesIn comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice.DesignPragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation.SettingGeneral practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk).ParticipantsPatients requesting same-day consultations.InterventionsPractices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation.Main outcome measuresPrimary – primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary – resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care.ResultsOf 20,990 eligible randomised patients (UCn = 7283; GPTn = 6695; NTn = 7012), primary outcome data were analysed for 16,211 patients (UCn = 5572; GPTn = 5171; NTn = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated with a marginal increase in primary outcome contacts by 4% (RR 1.04, 95% CI 1.01 to 1.08). Triage was associated with a redistribution of primary care contacts. Although GPT, compared with UC, increased the rate of overall GP contacts (face to face and telephone) over the 28 days by 38% (RR 1.38, 95% CI 1.28 to 1.50), GP face-to-face contacts were reduced by 39% (RR 0.61, 95% CI 0.54 to 0.69). NT reduced the rate of overall GP contacts by 16% (RR 0.84, 95% CI 0.78 to 0.91) and GP face-to-face contacts by 20% (RR 0.80, 95% CI 0.71 to 0.90), whereas nurse contacts increased. The increased rate of primary care contacts in triage arms is largely attributable to increased telephone contacts. Estimated overall patient–clinician contact time on the index day increased in triage (GPT = 10.3 minutes; NT = 14.8 minutes; UC = 9.6 minutes), although patterns of clinician use varied between arms. Taking account of both the pattern and duration of primary outcome contacts, overall costs over the 28-day follow-up were similar in all three arms (approximately £75 per patient). Triage appeared safe, and no differences in patient health status were observed. NT was somewhat less acceptable to patients than GPT or UC. The process evaluation identified the complexity associated with introducing triage but found no consistency across practices about what works and what does not work when implementing it.ConclusionsIntroducing GPT or NT was associated with a redistribution of primary care workload for patients requesting same-day consultations, and at similar cost to UC. Although triage seemed to be safe, investigation of the circumstances of a larger number of deaths or admissions after triage might be warranted, and monitoring of these events is necessary as triage is implemented.Trial registrationCurrent Controlled Trials ISRCTN20687662.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 13. See the NIHR Journals Library website for further project information.

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Section: Patient Experiencementioning

confidence: 99%

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

Campbell

Fletcher

Britten

et al. 2015

Health Technology Assessment

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“…The involvement of a supervising PCP at the call center (telephone PCP), computerized decision support systems, electronic patient records, and other organizational factors might influence the number of follow-up contacts. 3 Previous research showed that delays in answering calls or calling back and shorter consultations were associated with a more negative evaluation, 18 and the presence of a telephone PCP seemed to be related to a more positive evaluation of nurse telephone consultation. 8,19 Better insight into determinants of follow-up contacts could provide guidance for decision makers in their efforts to improve the efficiency of out-of-hours care.…”

mentioning

confidence: 99%

Follow-up After Telephone Consultations at Out-of-Hours Primary Care

Huibers¹,

Koetsenruijter²,

Grol³

et al. 2013

The Journal of the American Board of Family Medicine

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Background: After a contact with a primary care physician (PCP) cooperative for out-of-hours care, many patients have subsequent contact with health care. Little is known about the factors associated with these follow-up contacts. The objective of this study was to examine whether patient experiences with nurse telephone consultations and the cooperative's organizational characteristics were associated with the probability of follow-up contact.Methods :

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“…Eight publications described patient satisfaction after the consultation provided by the teleconsultation centers 17,19,25,26,39,42–44. Other settings include: the management of same-day appointments;6 the provision of teleconsultation services by physicians outside of specialized telemedicine institutions;19,23,45,46 maritime telemedicine;30 prison medicine;24 and teledermatology services 23.…”

Section: Resultsmentioning

confidence: 99%

“…The timing of instrument administration varied considerably across the studies. In addition, 16 publications (52%) reported the distribution of the questionnaires within 7 days of the consultation,6,19–24,27,32–34,36,37,40–42 seven studies (23%) between 14–28 days,17,18,26,28,38,39,44 and one publication (3%) reported a latency of 4–16 months 30. Also, seven (23%) studies did not report on the timing of the instrument’s administration (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review

Iseli¹,

Kunz²,

Blozik³

2014

PPA

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BackgroundPatient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services.ObjectivesOur objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis.MethodsWe searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables.ResultsWe included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales.ConclusionA majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation.

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Delays in response and triage times reduce patient satisfaction and enablement after using out-of-hours services

Cited by 24 publications

References 22 publications

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial)

Follow-up After Telephone Consultations at Out-of-Hours Primary Care

Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review

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