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PubMed2005

Equivalence of mail and telephone responses to the CAHPS Hospital Survey.

OBJECTIVE: To estimate the effect of survey mode (mail versus telephone) on reports and ratings of hospital care. DATA SOURCES/STUDY SETTING: The total sample included 20,826 patients discharged from a group of 24 distinct hospitals in three states (Arizona, Maryland, New York). We collected CAHPS data in 2003 by mail and telephone from 9,504 patients, of whom 39 percent responded by telephone and 61 percent by mail. STUDY DESIGN: We estimated mode effects in an observational design, using both propensity score blocking and (ordered) logistic regression on covariates. We used variables derived from administrative data (either included as covariates in the regression function or used in estimating the propensity score) grouped in three categories: individual characteristics, characteristics of the stay and hospital, and survey administration variables. DATA COLLECTION/EXTRACTION METHODS: We mailed a 66-item questionnaire to everyone in the sample and followed up by telephone with those who did not respond. PRINCIPAL FINDINGS: We found significant (p<.01) mode effects for 13 of the 21 questions examined in this study. The maximum magnitude of the survey mode effect was an 11 percentage-point difference in the probability of a "yes" response to one of the survey questions. Telephone respondents were more likely to rate care positively and health status negatively, compared with mail respondents. Standard regression-based case-mix adjustment captured much of the mode effects detected by propensity score techniques in this application. CONCLUSIONS: Telephone mode increases the propensity for more favorable evaluations of care for more than half of the items examined. This suggests that mode of administration should be standardized or carefully adjusted for. Alternatively, further item development may minimize the sensitivity of items to mode of data collection.

Data Collection↗
PubMed1998

Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial. The South Wiltshire Out of Hours Project (SWOOP) Group.

OBJECTIVE: To determine the safety and effectiveness of nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls. DESIGN: Block randomised controlled trial over a year of 156 matched pairs of days and weekends in 26 blocks. One of each matched pair was randomised to receive the intervention. SETTING: One 55 member general practice cooperative serving 97 000 registered patients in Wiltshire. SUBJECTS: All patients contacting the out of hours service or about whom contact was made during specified times over the trial year. INTERVENTION: A nurse telephone consultation service integrated within a general practice cooperative. The out of hours period was 615 pm to 1115 pm from Monday to Friday, 1100 am to 1115 pm on Saturday, and 800 am to 1115 pm on Sunday. Experienced and specially trained nurses received, assessed, and managed calls from patients or their carers. Management options included telephone advice; referral to the general practitioner on duty (for telephone advice, an appointment at a primary care centre, or a home visit); referral to the emergency service or advice to attend accident and emergency. Calls were managed with the help of decision support software. MAIN OUTCOME MEASURES: Deaths within seven days of a contact with the out of hours service; emergency hospital admissions within 24 hours and within three days of contact; attendance at accident and emergency within three days of a contact; number and management of calls in each arm of the trial. RESULTS: 14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. Conclusions Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective.

Adolescent↗
PubMed2003

Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial.

OBJECTIVE: To determine whether routine review by telephone of patients with asthma improves access and is a good alternative to face to face reviews in general practices. DESIGN: Pragmatic, randomised controlled trial. SETTING: Four general practices in England. PARTICIPANTS: 278 adults who had not been reviewed in the previous 11 months. INTERVENTION: Participants were randomised to either telephone review or face to face consultation with the asthma nurse. MAIN OUTCOME MEASURES: Primary outcome measures were the proportion of participants who were reviewed within three months of randomisation and disease specific quality of life, as measured by the Juniper mini asthma quality of life questionnaire. Secondary outcome measures included the validated "short Q" asthma morbidity score, nursing care satisfaction questionnaire score, and length of consultation. RESULTS: Of 137 people randomised to telephone consultation, 101 (74%) were reviewed, compared with 68 reviewed (48%) of the 141 people in the surgery group, a difference of 26% (95% confidence interval 14% to 37%; P<0.001; number needed to treat 3.8). Three months after randomisation the two groups did not differ in the Juniper score (risk difference -0.07 (95% confidence interval -0.40 to 0.27) or in satisfaction with the consultation (risk difference -0.07 (-0.27 to 0.13)). Telephone consultations were on average 10 minutes shorter than reviews held in the surgery (mean difference 10.7 minutes (12.6 to 8.8; P<0.001)). CONCLUSIONS: Compared with face to face consultations in the surgery, telephone consultations enable more people with asthma to be reviewed, without clinical disadvantage or loss of satisfaction. A shorter duration means that telephone consultations are likely to be an efficient option in primary care for routine review of asthma.

Asthma↗
PubMed1992

Use of telephone enquiries to a microbiology laboratory as a proxy measure of reporting efficiency.

AIMS: To assess the efficacy of a bacteriology service in respect of the time interval between collection of specimen and receipt of final report using the number and type of incoming telephone enquiries as a proxy measure. METHODS: For three months, all incoming telephone enquiries regarding the results of bacteriology specimens were monitored. Specimen type, date of sampling, the sender's location and the reason for making the telephone enquiry were recorded. RESULTS: The number of telephone enquiries made during the study was 1170, about 5% of the total number of samples received. Most enquiries related to results of urine cultures. These accounted for 33.9% of the calls, but only 5% of the total number of urines cultured. Enquiries relating to blood cultures were the next largest group accounting for 14.9% of calls, but 11% of the blood cultures received resulted in a telephone enquiry. The most frequent reason for making the telephone call was that the sender had not received the final report. CONCLUSIONS: Clinicians may have unrealistic expectations of the time taken to examine a specimen. A requirement for reporting sterile blood cultures after a shorter incubation period was found, and the value to patient management of earlier reporting of negative urine samples was identified.

Bacteriology↗
PubMed1999

Validity of telephone interview data for vascular disease risk factors in a racially mixed urban community: the Northern Manhattan Stroke Study.

The aims of our study were to assess the validity and reliability of a telephone survey instrument designed to measure vascular disease risk factors and to assess whether these measurements were influenced by age, gender, race/ethnicity, or other sociodemographic variables. Subjects were sampled and interviewed using random digit dialing methodology from the multiethnic community of northern Manhattan. For the validity study, 261 consecutive subjects were clinically assessed in-person within 60 days of the telephone interview. A retest reliability study of the telephone interview was conducted in 92 randomly selected subjects within 30 days of the initial interview. The telephone interview instrument had a sensitivity of more than 55% and a specificity of 74% or greater for various vascular disease risk factors. Sensitivity, specificity, and positive predictive value did not vary significantly or systematically among whites, blacks, and Hispanics, but subjects with access to health care were more likely to provide valid data. The reliability substudy indicated a good reliability for the telephone interview. These results support the validity of telephone interviews for estimating the prevalence of vascular risk factors in urban populations.

Age Factors↗
PubMed2006

Remote treatment of panic disorder: a randomized trial of internet-based cognitive behavior therapy supplemented with telephone calls.

OBJECTIVE: This study evaluated a 10-week Internet-based bibliotherapy self-help program with short weekly telephone calls for people suffering from panic disorder with or without agoraphobia. METHOD: After the authors confirmed the diagnosis by administering the Structured Clinical Interview for DSM-IV by telephone, 60 participants were randomly assigned to either a wait-listed control group or a multimodal treatment package based on cognitive behavior therapy plus minimal therapist contact via e-mail. A 10-minute telephone call was made each week to support each participant. Total mean time spent on each participant during the 10 weeks was 3.9 hours. The participants were required to send in homework assignments before receiving the next treatment module. RESULTS: Analyses were conducted on an intention-to-treat basis, which included all randomly assigned participants. From pretreatment to posttreatment, all treated participants improved significantly on all measured dimensions (bodily interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). Treatment gains on self-report measures were maintained at the 9-month follow-up. A blind telephone interview after the end of treatment revealed that 77% of the treated patients no longer fulfilled the criteria for panic disorder, whereas all of the wait-listed subjects still suffered from it. CONCLUSIONS: This study provides evidence to support the use of treatment distributed via the Internet with the addition of short weekly telephone calls to treat panic disorder. Replication should be made to compare self-help and telephone treatment based on cognitive behavior methods with nonspecific interventions.

Adult↗
PubMed1989

Telephone speech comprehension with use of the nucleus cochlear implant.

The reported telephone usage by cochlear implant recipients has become a major issue of controversy. Although patients and clinicians report good communication skills via the telephone, no standardized tests have been used and no quantifiable results have been reported. In an effort to determine the extent to which our better-performing patients can use the telephone, we established a clinical protocol to assess their ability to recognize speech, taking into consideration the problems inherent in telephone testing. Eight cochlear implant recipients were administered the NU-6 Monosyllabic Word Test and the City University of New York Topic Related Sentences under the following listening conditions: soundfield in a soundproof suite and via telephone within the hospital, locally, and long-distance. Twenty-three percent of the patients implanted at New York University Medical Center demonstrated a significant degree of telephone communication ability.

Cochlear Implants↗
PubMed2000

The relative costs and benefits of telephone interviews versus self-administered diaries for daily data collection.

This article compares two methods of collecting daily data: self-administered diaries and telephone interviews. Study participants included 44 men and 56 women between the ages of 16 and 35 who participated in a larger study of drinking, drug use, and sexual activity. Participants were randomly assigned to either the written diary or the telephone interview conditions; question wording and format were identical in both conditions. Daily data were collected for a period of 8 weeks. Results indicate that although telephone interviews resulted in slightly more missed days of data collection, they generally yielded less item-level missing data, produced cleaner data and therefore were less costly to process, and were as palatable to participants as self-administered diaries. Except for reports of drinking and vegetable consumption, telephone and diary conditions did not differ in the amount of behavior reported; more drinking and vegetable consumption were reported with telephone interviews, however. Telephone interviews also imposed considerably higher overall personnel costs.

Adolescent↗
PubMedDate not supplied

Time-tradeoff values and standard-gamble utilities assessed during telephone interviews versus face-to-face interviews.

The purpose of this study was to compare time-tradeoff values and standard-gamble utilities obtained during telephone interviews with those obtained through face-to-face interviews. Sixty-five patients with peripheral arterial occlusive disease completed both interviews. One week prior to the telephone interview, the patients received by mail a questionnaire in which the value and utility measures were presented in writing. The face-to-face interviews used the same questions, but the interviewer used visual aids. The mean time-tradeoff values were 0.84 (SD 0.20) vs 0.86 (SD 0.17) for the telephone and face-to-face interviews, respectively (p = 0.31). The mean standard-gamble utilities were 0.93 (SD 0.16) vs 0.92 (SD 0.17) for the telephone and face-to-face interviews, respectively (p = 0.26). In conclusion, telephone interviews yield similar time-tradeoff values and standard-gamble utilities compared with face-to-face interviews, suggesting that telephone interviews can replace face-to-face interviews.

Adult↗
PubMed2005

Do older patients feel able to cope with illness following telephone consultations? A multi-practice survey in the UK.

BACKGROUND: Worldwide, patients are offered a telephone consultation as a first point of access to a health care professional. Whilst older patients form a significant proportion of callers, this group has expressed reservation about consultations that preclude a physical examination. OBJECTIVE: This study compares how two groups of patients (< 70 years, > or = 70 years) perceive their ability to cope with illness following a telephone consultation. METHODS: Nine hundred and fifty-six patients from deprived inner city areas receiving telephone consultations with a General Practitioner (GP)/Family doctor or nurse at five practices in South Yorkshire, UK were surveyed within 24 h of the consultation. A 49% response rate was achieved; the mean age of respondents in the respective groups was 78.5 years and 48 years. The questionnaire included the Patient Enablement Instrument (PEI), a self-reported measure of patients' ability to cope with illness measure of patients' ability to cope with illness and supplementary questions on access to GPs in the practice. RESULTS: There was a low response rate from younger patients and males in particular. Ethnic minority groups were hardly represented among the respondents. How ever, scores on the PEI following telephone consultations were no different between older and younger respondents (Mann-Whitney U test, p = 0.56). Regression analysis with PEI scores as the dependent variable and fitting age and differences in responses to the questionnaire as explanatory variables yielded an R(2) of 0.02 suggesting that 'age' per se was a poor predictor of 'enablement'. CONCLUSIONS: These data support an inclusive policy in the provision of telephone access to health care professionals in primary care. We conclude that older patients are not disadvantaged by consulting a primary care professional by telephone.

Adaptation, Psychological↗
PubMed2005

Use of telephone interviews to follow up patients after total hip replacement.

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used. Since range of motion and deformity cannot be assessed by telephone, only pain and function were assessed. The maximum possible score was 100. Patients attending follow-up clinics were contacted by telephone one to two weeks prior to their appointment and a telephone assessment was completed. This was then compared with a face-to-face assessment in the subsequent clinic. The mean hip score obtained with the telephone interview was 85.2 and the mean hip score at face-to-face assessment was 86.1. The mean of the differences between the individual scores was -0.9 (SD 5.5). This difference was not significant ( P=0.11). Only three patients had a clinically significant difference (>20 points) between the two methods. Telephone questionnaires may be a useful adjunct to face-to-face assessment for patient follow-up after total hip replacement.

Arthroplasty, Replacement, Hip↗
PubMed2005

Telephonic transmission of 12-lead electrocardiograms during acute myocardial infarction.

To test the feasibility of a small and simple system for telephonic transmission of 12-lead electrocardiograms (ECGs), 70 patients with acute coronary syndrome admitted to the cardiac care unit (CCU) were included in a feasibility study. The transmission system consisted of a belt with multiple electrodes, which was positioned around the chest. The ECG signal was sent to a call centre via a standard telephone line. In parallel, a standard 12-lead ECG was recorded on site. In a retrospective analysis, each lead of the transmitted ECG was compared with the on-site 12-lead ECG with regard to ST-segment changes and final diagnosis. In all 37 patients with acute ST-elevation myocardial infarction, the diagnosis was correctly established on the basis of telephone-transmitted ECGs. In 96% of limb and 88% of chest leads, ST elevations which were visible in standard ECGs were correctly displayed on telephonically transmitted ECGs. In the remaining 33 patients no false-positive diagnosis was made using transtelephonic ECG analysis. A control group of 31 patients without apparent heart disease showed high concordance between standard ECGs and telephonically transmitted ECGs. Telephonically transmitted 12-lead ECGs interpreted by a hospital-based internist/cardiologist might allow a rapid and accurate diagnosis of ST-elevation myocardial infarction and may increase diagnostic safety for the emergency staff during prehospital decision making and treatment of acute myocardial infarction.

Acute Disease↗
PubMed2006

A systematic review of telephone-based interventions for mental disorders.

To assess the effectiveness of telephone-based interventions for mental illness, a systematic search of the literature was conducted using the databases PsycINFO and PubMed, and the search engine Google Scholar. The search identified 14 studies evaluating telephone-based interventions in the areas of depression (n = 6), anxiety (n = 3), eating disorders (n = 3), substance use (n = 1) and schizophrenia (n = 1). Although these studies provide evidence that telephone interventions can be effective, the few studies conducted, small sample sizes and lack of randomized controlled trial methodology prevent firm conclusions from being drawn. The articles reviewed suggest that an effective telephone intervention includes clearly structured therapy sessions and homework tasks. However, further evidence using large-scale, randomized controlled trials must be obtained in order to inform government and telephone counselling agencies about the efficacy of telephone interventions.

Anxiety Disorders↗
PubMedDate not supplied

Noise evaluation and estimation of some specific and non-specific health indicators in telephone operators.

Noise loading has a considerable effect on the working conditions of telephone operators. This study comprises noise field and laboratory measurements and field investigation of workers at three departments of the Telephone and Telegraph Communication Services in Sofia. Noise measurements revealed a background noise in the range of 57.4-70.6 dB A in the International Department, 70.6-71.7 dB A in the Intercity Department and 68.7-70.1 dB A in the Information Department and highest intensities of 63.5, 62.1 and 58.2 dB for frequencies of 0.5, 1 and 2 kHz. The registered noise (Leq) from the inner telephone receiver-microphone (type Star-set) was in the range of 78.4-86.6 dB A. Peaks of 90-96 dB A were registered during different working operations ("dialing", "speaking", "fax", "occupied") with duration less than 5s and stochastic appearance during the 15 min measuring periods. A total of 260 female telephone operators (mean age 36.7 +/- 8.22 years and mean length of employment 12.7 +/- 7.12 years) with similar job activities at the three departments were investigated. No marked decreased hearing sensitivity for 0.5, 1, 2, 4, 6 and 8 kHz was observed. A high percentage of the examinees gave positive answers in different questionnaires regarding subjective symptoms (psychological, neurovegetative, neurological), mental health, depression and anxiety. An elevated urine excretion of catecholamines (11-OCS, adrenalin and noradrenalin) was found during the morning and afternoon working shifts. The intensity of the noise and its annoying effect were subjectively estimated as "high" and "very high" by most of the examined telephone operators. In a large percentage of operators in the Intercity Department, the changes of the audiometric, psychological and biochemical examinations were more pronounced. The obtained results indicate that redesign of the work place should be undertaken in order to prevent health effects on the telephone operators.

Adult↗
PubMed2004

Follow-up after a pediatric emergency department visit: telephone versus e-mail?

OBJECTIVE: The Internet has become in recent years an unlimited source of health-related information and revolutionized health information access. Follow-up after an emergency department (ED) visit is important for continuity of care but is difficult to achieve. We conducted this study to determine whether e-mail could become a method for a follow-up contact after leaving the pediatric ED. METHODS: Over a 2-month period, parents who had a telephone line and e-mail access and whose child was discharged from the ED at the Hospital for Sick Children in Toronto were randomized to receive an e-mail or a telephone follow-up. Main outcome measure was the response rates by parents to the telephone or e-mail. RESULTS: A total of 265 (79%) of the 337 families who were approached had Internet access, and the majority (75%) check e-mails at least once a day. Eighty-seven percent (85 of 98) and 53% (53 of 100) of the families who were contacted by telephone or e-mail, respectively, were reached within an average of 17 and 46 hours, respectively. Fourteen percent of families from the study population were unreachable either by telephone or by e-mail. Most (57%) parents who did not respond to the e-mail did not check or did not remember reading the e-mail or had trouble with access. Ten percent of the e-mails were undeliverable. CONCLUSIONS: The telephone is better than e-mail as a follow-up channel with families of children who visit the pediatric ED. The main reason for not responding to e-mails is "technical problems." E-mail could be a mean for follow-up contact for part of our patient population, especially for nonurgent purposes.

Aftercare↗
PubMed2005

Inclusion of people with disabilities in telephone health surveillance surveys.

OBJECTIVES: Telephone survey data are widely used to describe population health, but some fear that people with disabilities cannot participate. We tested the hypothesis that a telephone survey would underrepresent adults with disabilities, and that the adults with disabilities who responded would report lower prevalences of sensory, mental, self-care, and multiple limitations than those observed in people with disabilities in the general population. METHODS: We compared characteristics of adults with disabilities identified by the 2001 Washington State Behavioral Risk Factor Surveillance Survey (BRFSS) to Washington adults with disabilities in the Census 2000 Supplementary Survey (C2SS), to 2 BRFSS Disability Supplements, and to the Washington State Population Survey. All except the C2SS are telephone surveys. RESULTS: Contrary to expectations, post hoc analyses of all telephone surveys found significantly higher prevalence of disability in the Washington adult population than did the C2SS. The hypothesis of more sensory, mental, and self-care limitation in telephone disability samples was supported in only 2 of 11 instances in which a disability sample was asked about 1 of these limitations. Findings were not explained by differences in disability definition or type of informant. CONCLUSIONS: These results suggest that population telephone surveys do not underrepresent adults with disabilities. The counterintuitive finding of their higher survey participation raises further questions.

Activities of Daily Living↗
PubMed1997

Telephone support as an adjunct to transdermal nicotine in smoking cessation.

OBJECTIVES: Transdermal nicotine patches have shown considerable promise in improving smoking cessation outcomes. The present study assessed telephone support as an adjunct to a managed care-based, single-session group orientation smoking cessation program with nicotine patch therapy. METHODS: The unit of randomization was the orientation session (n = 35). Subjects (n = 509) were randomly assigned to a group session without telephone support, the session plus access to a toll-free help line, or the session with telephone help line plus active telephone outreach. RESULTS: Contrary to hypothesis, there were no differences between treatment conditions. Overall abstinence rates were 22% at 6 months and 21% at 1 year. Fewer than 1% of eligible subjects called the toll-free help line. An average of 3.8 of a possible 4 calls were completed in the telephone outreach condition. CONCLUSIONS: Abstinence results obtained in this program were comparable to those obtained with more extensive counseling. However, there was no evidence of benefit from telephone support beyond the initial physician-led group orientation session.

Administration, Cutaneous↗
PubMed1986

Does telephone counselling have preventive value?

Major developments in health care frequently result not from careful planning by professional health care providers, but from social processes whereby a heightened awareness of need leads to new strategies and resources for community support. The development of a network of hospitals in eighteenth-century England was 'the outcome of individual initiative and of coordinated voluntary effort and subscription'. The evolution of mental health care in the United States was influenced greatly by the enthusiasm and advocacy of reformers such as Dorothea Dix and Clifford Beers. The development of telephone counselling services, now an integral part of community mental health care, resulted from a recognition that the psychosocial stresses of twentieth-century life could perhaps be alleviated through support offered by telephone. This recognition has led to the mobilising of many thousands of volunteers who serve in hundreds of telephone counselling services worldwide. For telephone counselling as for many other new developments, the initial period of growth has been followed by one of reflection and evaluation. That telephone counselling services have earned a place in the community mental health network and are here to stay is beyond doubt, though the ways in which they can be used to greatest advantage are still being clarified. At the level of primary prevention there is as yet no convincing evidence that telephone counselling services have reduced the incidence of psychological disorder. It must be added, however, that mental health professionals have also had relatively little success in reducing the occurrence of psychological disorder, and only with carefully designed programs directed toward specific at-risk groups. The evidence is more encouraging at the level of secondary prevention.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Mental Health Services↗