Intended for healthcare professionals

Letters

Telephone use in primary care

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7363.547 (Published 07 September 2002) Cite this as: BMJ 2002;325:547

Programme to shape demand has been started in several practices

  1. John Oldham, head (katie.bowden{at}manchester.nwest.nhs.uk)
  1. National Primary Care Development Team, Manchester M60 7LP
  2. Cystic Fibrosis Centre
  3. Cystic Fibrosis Centre
  4. Department of Paediatrics, University of Florence, Anna Meyer Children's Hospital, 50132 Florence, Italy

    EDITOR—Toon's editorial on using telephones in primary care raises several points, in particular the diversity of opinion about the relative merits of clinical skill versus computer algorithms.1 He may be unaware of some primary care activity that is moving events on.

    The primary care collaborative, run by the National Primary Care Development Team, aims to improve access to primary care as one of its three principal objectives. The method advocated is “advanced access,” and a key element of this is the need to shape demand. This can be done by telephone consultation. Telephones can be used for managing same day demand, follow up appointments, and other queries in the same way that was used in the practice that Toon looked at.

    The practices track their own data, but collectively we believe that there is a 30-50% reduction in the need for face to face consultation as a result of telephone management of same day demand, and a 15-20% reduction in the need for follow up consultations. These figures are in line with those reported for telephone consultation by Jiwa et al.2 Not only are patients more satisfied but they feel less need to book to see their general practitioner if they know that access is easier.

    Around 1000 practices covering seven million patients have now been involved in the first phase of the primary care collaborative. By the end of this year we should have practices involved in every primary care trust. The government sponsors and has been most supportive of the programme.

    Finally, telephone consultation is only one means of shaping demand; email consultations, expert patients (particularly those with chronic illness), and skill mix are also increasingly used solutions.

    References

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    Telephones have proved useful in managing cystic fibrosis

    1. Giovanni Taccetti, paediatrician (g.taccetti{at}meyer.it),
    2. Filippo Festini, cystic fibrosis nurse specialist,
    3. Maurizio de Martino, full professor of paediatrics
    1. National Primary Care Development Team, Manchester M60 7LP
    2. Cystic Fibrosis Centre
    3. Cystic Fibrosis Centre
    4. Department of Paediatrics, University of Florence, Anna Meyer Children's Hospital, 50132 Florence, Italy

      EDITOR—Toon raises the question of telephone consultation for education and monitoring of chronic diseases.1 Cystic fibrosis is one of the most problematic chronic diseases, and information regarding telephone consultation is scanty, mainly covering neonatal screening procedures and genetic counselling.24

      Altogether 160 patients (mean (SD) age 16.2 (10.75) years; median 14, range 1-49) are currently treated at the Tuscan referral centre, where it was decided to reserve a time for telephone consultation. We received 1081 calls (daily average 5.14) over seven months. The calls were recorded and notes made of the personal data of the patient, the time and day of the week, the member of hospital staff the call was addressed to, the reason for the call, and the correlation between the patient's clinical conditions and the number of calls.

      Two hundred (18.5%) telephone requests regarded patients aged 0-6, 217 (20.1%) patients aged 7-12, and 238 (22%) patients aged 13-18, and 426 (39.4%) were from adult patients. Most calls (295 (27.3%)) were received on Mondays and Thursdays (226 (20.9%)). Only 357 (33%) calls took place in the specified time slot. The calls were directed to doctors in 938 (86.8%) cases.

      The calls mainly concerned aspects of patients' medical care: 285 (26.4%) were to request test results, 252 (23.3%) were to request information about medical treatment, 225 (20.8%) were due to a worsening clinical condition, 77 (7.1%) were to discuss the situation with the family doctor, 75 (6.9%) were to fix appointments, 59 (5.5%) were to ask for drug prescriptions, 15 (1.4%) were to ask for explanations of medical treatment, 8 (0.8%) were to ask for medical certificates, and 85 (7.8%) were for other reasons. A negative correlation (r = −0.52, P<0.05) was found between lung function (measured as forced expiratory volume in one second) and number of phone calls.

      Telephone consultations are an important part of the management of cystic fibrosis.5 They helped patients and their families to save time and costs, although we need to quantify better both the limits and the benefits for health professionals. This service has improved the quality of management of cystic fibrosis, although it has been impossible to calculate whether these calls reduced the number of appointments. The Italian health system would do well to investigate the possibilities of managing chronic diseases effectively by using telephone consultation and thereby reducing pressure on medical staff and saving them valuable time.

      References

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