Evaluation of telephone first approach to demand management in English general practice: observational study

Abstract

Objective To evaluate a “telephone first” approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation. Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data. Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England. Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies. Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies’ protocols. Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices −38%, 95% confidence interval −45% to −29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval −1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs. Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care.

Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

“…The literature highlights both positive and negative effects of telephone consultations on workload. 11,22,23 The present study enhances these findings by adding the trainees' points of view. Furthermore, although the study did not look specifically at patient satisfaction to telephone consultations, 24 positive patient feedback was rated highly as one of the reasons for positive experiences.…”

“…10 Telephone consultations may adversely affect patient safety, owing to less data gathering and rapport building than face-to-face consultations, and they may not reduce workload. 3,11 There is, therefore, a growing call for further professional development in delivering telephone consultations in order to improve quality and to guide changes in undergraduate and postgraduate training. 12 Greater understanding of the views and experiences of GPs is needed in training those responsible for shaping and delivering future primary care, particularly in terms of GPs' training needs, curricular requirements, and confidence in handling telephone consultations.…”

Teleconsulta: uma Revisão Integrativa da Interação Médico-Paciente Mediada pela Tecnologia

“…Using this classification, the articles reported that the telephone can be used as an additive, alternative or partially substitutive type of consultation 38,[43][44] . E-mail, on the other hand, has been used in an additive 16 or partially substitutive 16,20 consultation, especially for scheduling appointments, renewing prescriptions, solving doubts and to present test results 19 .…”

Telephone consultations

“…Fact— The scope for telephone consultations is wide and includes prevention, hospital specialties, and surgical and psychiatric consultations56101112…”

“…Telephone consultations have the potential to improve access, convenience, and choice and are the most common alternative to face-to-face consultations 2. Comparative studies show that patient are equally satisfied with both forms of consultation 345. However, randomised controlled trials and time series studies show that telephone consultations do not necessarily reduce workload for clinicians 56…”