Introducing Primary Care Telephone Visits: An Urban Safety-Net Community Clinic Experience

Abstract

Background: Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. Measures: Patient and physician surveys, and physician focus groups. Results: Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. Conclusions: Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

Seven Day Safety Net Service

“…It could be argued that this is a more effective service model than clinicians calling patients, which in contrast may only have 30-35% of calls completed. 12,13 The cases of inappropriate and/or recurrent calls account for the minority of patients.…”

“…A 9 year study was conducted in a university hospital emergency department in the USA as a means of follow up and led to improved patient satisfaction and reduced malpractice lawsuits. 13 This design of follow up can be labour intensive if many scheduled calls go unanswered. 14 Telephone follow up calls have been identified as an alternative to face to face clinic consultations for postoperative patients with positive outcomes, concluding that this could be an alternative, preferable option.…”

Nurse practitioner satisfaction with in-person versus telehealth chronic care delivery

“…Telehealth services (i.e., synchronous telephone and audio/video visits) have generally maximized NPs' scope of practice, allowing them to provide diagnostic evaluation, interstate consultation, and care to patients in the home setting (Center for Connected Health Policy, 2020b; Centers for Medicare & Medicaid Services, 2020; Frey & Chiu, 2021; Hurst, 2016). Before the pandemic, research on NP telehealth care provision was focused either on (a) bolstering NP telehealth education (Kelly et al, 2017; List et al, 2019; Rutledge et al, 2017), job satisfaction (Choi & De Gagne, 2016; Hoff et al, 2019; Poghosyan et al, 2017), and implementation of NP-led telehealth interventions (Koivunen & Saranto, 2018) or on (b) exploring patient, physician, or caregiver satisfaction (Flodgren et al, 2015; Kyanko et al, 2018; Marsteller et al, 2010; Polinski et al, 2016). There is a paucity of literature related to NP satisfaction with chronic disease care delivery and quality of care using telehealth compared with in-person visits.…”

The challenges of telephone consultation program during severe acute respiratory syndrome-coronavirus-2 epidemic in Iran: A qualitative study

“… 9 The results of a study regarding telephone consultations showed the satisfaction of 84% of patients. 10 Along with the advantages of telephone consultations, such as the ease of access, low cost, and time efficiency, disadvantages, such as weakening of effective relationships, jeopardizing the confidentiality of information, and inability to perform physical examinations, have been declared. 11 , 12 Providing remote services may have many challenges for service providers and bring many questions about its consequences.…”