Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Murdoch, Jamie; Varley, Anna; Fletcher, Emily; Britten, Nicky; Price, Linda; Calitri, Raff; Green, Colin; Lattimer, Valerie; Richards, Suzanne H; Richards, David; Salisbury, Chris; Taylor, Rod S; Campbell, John

doi:10.1186/s12875-015-0263-4

Cited by 27 publications

(27 citation statements)

References 21 publications

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“…In contrast, NHS Direct nurses had clearly been using the CDSS for much longer and therefore may explain why years of experience was shown to be beneficial in O’Cathain's study. Added to this a number of nurses who were interviewed as part of the ESTEEM process evaluation reflected that the CDSS software was not suitable for use in a primary care setting ( Murdoch et al, 2015b ). There are therefore a combination of factors which might have all contributed to the nurses referring a higher proportion of patients for follow-up within the practice.…”

Section: Discussionmentioning

confidence: 99%

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

Varley

Warren

Richards

et al. 2016

International Journal of Nursing Studies

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BackgroundNurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings.ObjectiveTo investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition.DesignQuestionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage.Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse.Settings15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK.Participants45 nurse practitioners and practice nurse trained in the use of clinical decision support software.MethodsWe investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling.ResultsValid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55).ConclusionNurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation.

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Section: Discussionmentioning

confidence: 99%

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

Varley

Warren

Richards

et al. 2016

International Journal of Nursing Studies

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“…Health literacy trials frequently focus on the individual as problematic rather than the larger context and the demands placed on patients by complex modern healthcare systems [ 52 ]. Detailed, well thought-out patient participatory process evaluations within trials are rare, which means that patient experience and understanding of important factors such as patient-clinician relationships are missed [ 53 ]. Health promotion efforts, including health literacy RCTs, are prone to an underlying bias that if people are told and trained what to do, they will both do it and become healthier, when in reality the relationship between knowledge, behaviour and health outcome is complex and highly personal [ 54 , 55 ].…”

Section: Discussionmentioning

confidence: 99%

Methodological review: quality of randomized controlled trials in health literacy

Brainard

Wilsher

Salter

et al. 2016

BMC Health Serv Res

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BackgroundThe growing move towards patient-centred care has led to substantial research into improving the health literacy skills of patients and members of the public. Hence, there is a pressing need to assess the methodology used in contemporary randomized controlled trials (RCTs) of interventions directed at health literacy, in particular the quality (risk of bias), and the types of outcomes reported.MethodsWe conducted a systematic database search for RCTs involving interventions directed at health literacy in adults, published from 2009 to 2014. The Cochrane Risk of Bias tool was used to assess quality of RCT implementation. We also checked the sample size calculation for primary outcomes. Reported evidence of efficacy (statistical significance) was extracted for intervention outcomes in any of three domains of effect: knowledge, behaviour, health status. Demographics of intervention participants were also extracted, including socioeconomic status.ResultsWe found areas of methodological strength (good randomization and allocation concealment), but areas of weakness regarding blinding of participants, people delivering the intervention and outcomes assessors. Substantial attrition (losses by monitoring time point) was seen in a third of RCTs, potentially leading to insufficient power to obtain precise estimates of intervention effect on primary outcomes. Most RCTs showed that the health literacy interventions had some beneficial effect on knowledge outcomes, but this was typically for less than 3 months after intervention end. There were far fewer reports of significant improvements in substantive patient-oriented outcomes, such as beneficial effects on behavioural change or health (clinical) status. Most RCTs featured participants from vulnerable populations.ConclusionsOur evaluation shows that health literacy trial design, conduct and reporting could be considerably improved, particularly by reducing attrition and obtaining longer follow-up. More meaningful RCTs would also result if health literacy trials were designed with public and patient involvement to focus on clinically important patient-oriented outcomes, rather than just knowledge, behaviour or skills in isolation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1479-2) contains supplementary material, which is available to authorized users.

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“…2015 (18). Thus, CME for these common problems had low priority, both from an organizational and individual perspective.…”

Section: Discussionmentioning

confidence: 99%

Registered Nurses´ Views on Telephone Nursing for Patients with Respiratory Tract Infections in Primary Healthcare – A qualitative interview Study

Kaminsky

Aurin²,

Hedin

et al. 2020

Preprint

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Abstract Background: Telephone nursing in primary healthcare has been suggested as a solution to the increased demand for easy access to healthcare, increased number of patients with complex problems, and lack of general practitioners. Registered nurses’ assessments may also be of great importance for antibiotic prescriptions according to guidelines. The aim of this study was to describe registered nurses’ views of telephone nursing work with callers contacting primary healthcare centres regarding respiratory tract infections.Methods: A descriptive, qualitative study was performed through interviews with twelve registered nurses in Swedish primary healthcare. Results: The overarching themes for registered nurses’ views on telephone nursing were captured in two themes: professional challenges and professional support. These included three and two categories respectively: Communicate for optimal patient information; Differentiate harmless from severe problems; Cope with caller expectations; Use working tools; and Use team collaboration. Optimal communication for sufficiently grasping caller symptoms and assess whether harmful or not, without visual input, was underlined. This generated fear of missing something serious. Professional support used in work, were for example guidelines and decision support tool. Colleagues and teamwork collaboration were requested, but not always offered, support for the interviewed registered nurses.Conclusions: The study deepens the understanding of telephone nursing as an important factor for decreasing respiratory tract infection consultations with general practitioners, thus contributing to decreased antibiotic usage in Sweden. To cope with the challenges of telephone nursing in primary healthcare centres, it seems important to systematically introduce the use of the available decision support tool, and set aside time for inter- and intraprofessional discussions and feedback. The collegial support and team collaboration asked for is likely to get synergy effects such as better work environment and job satisfaction for both registered nurses and general practitioners. Future studies are needed to explore telephone nursing in primary healthcare centres in a broader sense to better understand the function and the effects in the complexity of primary healthcare.

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Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Cited by 27 publications

References 21 publications

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

Methodological review: quality of randomized controlled trials in health literacy

Registered Nurses´ Views on Telephone Nursing for Patients with Respiratory Tract Infections in Primary Healthcare – A qualitative interview Study

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