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PubMed2004

An assessment of the feasibility of telephone and email consultation in a chest clinic.

One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.

Computer Literacy↗
PubMed2002

Effectiveness of telephone support in increasing physical activity levels in primary care patients.

BACKGROUND: Physician counseling of patients to increase physical activity has had limited success in changing behavior. Providing organizational support to primary care providers and their patients may increase effectiveness. OBJECTIVE: This study evaluates the effectiveness of a telephone-based intervention to increase physical activity among patients who exercised <15 minutes daily and wanted to increase their physical activity over a 6-month period. DESIGN: This was a randomized controlled trial, conducted from 1997 to 1998, of 316 patients aged 18 to 65 who were recruited from a mailed health risk assessment. Baseline and 6-month post-intervention telephone assessments were conducted by telephone. SETTING: One family physician's patients in a suburban community. INTERVENTION: Three sessions of telephone-delivered motivational counseling. MAIN OUTCOME MEASURES: Physical activity score (11-item Physician-Based Assessment and Counseling for Exercise [PACE]) 6 months after the intervention. RESULTS: After adjusting for baseline exercise, there was a significantly higher level of self-reported exercise among individuals randomized to the intervention at the 6-month follow-up. The mean level of activity at follow-up for the intervention group was a PACE score of 5.37, compared to 4.98 in the control group (p<0.05). In the secondary analysis, which was limited to individuals who received the intervention, the effect was stronger (PACE score of 5.58 compared to 4.94, p<0.013). CONCLUSIONS: Patients can be recruited using a health-screening questionnaire to receive a telephone-delivered behavioral intervention to successfully increase their physical activity levels.

Adolescent↗
PubMed2002

Usefulness of telephone risk factor surveys in the New Mexico border region.

BACKGROUND: We sought to assess prevalence of behavioral risk factors and evaluate the usefulness of survey data gathered by telephone in the New Mexico border region. METHODS: This study compared behavioral risk factor data gathered from two probability sample surveys administered in 1998-1999, one by means of a telephone interview and the second face to face. Prevalence estimates for medical care access, injury, and chronic disease risk factors were compared by survey mode, overall, and stratified by income level. RESULTS: Risk factor prevalence estimates based on telephone interviews resemble estimates obtained from face-to-face interviews. Although risk factor prevalence estimated from face-to-face interviews were in general slightly greater than those from telephone interviews, none of these differences reached statistical significance. When data for each respective survey were examined by income level, prevalence estimates for comparable income groups in both surveys were in general agreement and estimates within survey increased with declining income. CONCLUSION: In the New Mexico border region, telephone survey data appear to be reasonably valid and offer opportunities for population-based health research.

Adolescent↗
PubMed1998

An examination of self- and telephone-administered modes of administration for the Australian SF-36.

The impact of administration mode on health-related quality of life measurement instruments has received little attention, especially for the SF-36. General community members were randomly selected to complete the Australian version of the SF-36 Health Survey using either telephone or mail modes. Modes were compared across a number of indices: data collection costs; consent rates and non-consent bias; data quality (completeness of data and internal consistency reliability); and response effects. Data collection costs were lower for the telephone mode. A significantly higher consent rate was achieved with the telephone mode. Those who were younger were more likely to refuse to participate when the mail mode was adopted, while older people were more likely not to consent to the telephone mode. The rate of missing responses was higher for the mail mode, while significant differences were found between modes in internal consistency reliability estimates. Health ratings were more favorable for the telephone administration. The results are discussed in light of the advantages and disadvantages of each administration mode.

Adolescent↗
PubMed2003

[Telephone activity in outpatient pediatric practice].

OBJECTIVES: To assess the amount of telephone activity in outpatient pediatric practice. METHODS: Seventy-nine pediatricians belonging to a continuing medical education group (Arepege) prospectively recorded data about all the telephone calls they took personally for 3 days, from 4 to 6 December 2000. They noted the number of calls each day and their duration, the caller, the reason for and the response to each call. RESULTS: In 3 days, the 79 pediatricians received 4413 calls, for a mean of 19 calls daily for each practitioner. The calls were brief, 86% of them lasting less than 2 min; each pediatrician spent an average of 26 min a day on the telephone; most calls (82%) came from children's mothers. The reasons for the calls were: request for appointment (1035 calls, 23.5%), request for advice not associated with an acute disease (1416 calls, 32%), the onset of acute symptoms (1961 calls, 44.5%). An appointment was made in 26% of the cases for which the reason for the call was illness. CONCLUSION: Pediatric private practice involves substantial telephone activity, which generates no healthcare costs, but does present risks that might be attenuated by the use of appropriate algorithms for conducting these telephone interviews.

Adult↗
PubMed2003

The reliability of telephone interviews compared with in-person interviews using memory aids.

PURPOSE: Information obtained by telephone interviews and in-person interviews is generally considered comparable, but it is unclear if extensive memory aids can be used effectively with telephone interviews. We compared a telephone interview to an in-person interview using the same questionnaire and memory aids in both. METHODS: A convenience sample of 103 women, aged 25 to 69 years, completed a telephone interview and at least four weeks later, completed an in-person interview. Memory aids included a life events calendar, cue lists, and worksheets. RESULTS: Agreement values, measured by kappa/weighted kappa, were as follows: parity (1.00), age at menarche (0.76), menopausal status (0.95), a history of reproductive organ surgery (0.98) or tubal ligation (0.91), self-reported infertility (0.76), and a first degree family history of breast/ovarian cancer (0.90). Agreement values for duration variables, measured by the intraclass correlation, were as follows: lactation (0.96), oral contraceptive use (0.98), any hormone replacement therapy (0.98), exclusive estrogen and progesterone therapy (0.83), and exclusive estrogen therapy (0.99). CONCLUSIONS: The good to excellent level of agreement found in this study indicates that telephone administration of our questionnaire with extensive memory aids is a reliable method of obtaining detailed exposure information relative to in-person interviews.

Adult↗
PubMed2005

Piloting the feasibility and effectiveness of print- and telephone-mediated interventions for promoting the adoption of physical activity in Australian adults.

This study examined the feasibility and effectiveness for increasing physical activity of a print-based intervention, and a print- plus telephone-mediated intervention among mid-life and older Australian adults. A randomised controlled trial study design was used. In mid-2002, 66 adults (18 men, 48 women) aged 45-78 years, who identified themselves as underactive, were recruited through advertisements and word-of-mouth at two sites (Melbourne and Brisbane), and randomised to either the print or print-plus-telephone mediated intervention group. Participants in both groups attended an initial briefing session, and over the 12-week intervention period received an instructional newsletter and use of a pedometer (both groups), and individualised telephone calls (print-plus-telephone group only). Self-reported physical activity data were collected at baseline, 12 and 16 weeks. Measures of self-reported global physical activity, moderate-vigorous intensity activity and walking all showed increases between baseline and 12 weeks for both intervention groups. These increases were generally maintained by 16 weeks, although participants in the print-plus-telephone group maintained slightly higher levels of global reported activity and walking (by approximately 30 mins/wk) than those in the print group. These interventions show potential for promoting initial increases in physical activity among mid-life and older Australian adults, and should be evaluated across more extended time periods.

Aged↗
PubMed2003

[Reliability and validity of evaluation data collected by telephone].

OBJECTIVES: Follow-up telephone interviewing is an increasingly popular method of quality assurance and therapy evaluation in child and adolescent psychiatry. However, the reliability and validity of data gathered in telephone interviews has not been investigated sufficiently. The current article examines the quality of the information gathered from the parents of former inpatients of a hospital for child and adolescent psychiatry. METHODS: In a sample of n = 32 cases a telephone interview was carried out, followed by a personal interview two weeks later. Data from both interviews were analyzed for correlations between the ratings by parents and experts. RESULTS: The results from the telephone interviews indicate sufficient, respectively good reliability and underscore the validity of these data. CONCLUSIONS: On the basis of these results, the standardized telephone interview developed in our group and used in the study can be applied as a reliable and valid method of controlling for treatment success in follow-up investigations. As the interview does not entail any great expenditures, it can be used in routine quality assurance.

Adolescent↗
PubMed1997

Effect of altered auditory feedback on people who stutter during scripted telephone conversations.

The effect of altered auditory feedback (AAF) conditions on stuttering during scripted telephone conversations was investigated. Nine adult participants made 15 scripted telephone calls to business in New York City. Alterations in the participants' auditory feedback signal were generated by a commercially available digital signal processor (Casa Futura Technologies Desktop Fluency System Model BTD-400) that shifted participants' speech one-half octave down in frequency, produced a 50-ms delay, or produced non-altered auditory feedback. The AAF effects produced by the digital signal processor were not perceived by the recipients of the telephone calls. The proportion of stuttering events per scripted telephone conversations were significantly reduced in the AAF conditions relative to the non-altered auditory feedback condition (p = .0004). Stuttering frequency was reduced by 55% and 60% for the FAF and DAF, respectively. These findings demonstrate the applicability of this technology to situations of daily living involving telephone use.

Adult↗
PubMed1998

Interviewing older people by telephone following initial contact by postal survey.

Although the use of the telephone for interviewing has become a commonly used and largely accepted research method, the literature on this subject makes it clear that certain reservations remain. Some of these relate to problems encountered when interviewing older adults by telephone and others concern the use of the telephone in interviews where there has been no prior face-to-face contact. The conclusions of others who have studied these two sets of problems in combination are that special difficulties exist. These conclusions are examined with reference to researchers' experiences of conducting a study on continence care, in which a postal survey (as opposed to face-to-face contact) preceded telephone interviews. Interviews were conducted with adults of all ages, including a high proportion of older people. Researchers encountered few major difficulties and were satisfied with both response rate and response quality. Research to compare the effects of a variety of initial contact modes on telephone interviews with both younger and older adults is recommended.

Aged↗
PubMed1999

Talking on the telephone with people who have experienced pain in hospital: clinical audit or research?

The adequacy of postoperative pain management in British hospitals appears insufficient to improve patient care, and much of the research and clinical audit in postoperative pain has failed to seek the patient's perspective. This paper reports on the findings from a semi-structured telephone interview survey which formed part of a hospital-wide audit on postoperative pain at a district general hospital in the south of England. Of a total of 360 completed audit questionnaires, 114 patients left their telephone number and 29 were interviewed. Content analysis revealed five main themes: inadequate information, pain at home, staff attitudes, expectations of pain, and ward atmosphere. Several patients identified insightful strategies that potentially could improve pain management. The telephone interview generated a richness of data that had not been reported before in this important area. Some authors view clinical audit and research as having different characteristics but this work raises important questions for both approaches when using the semi-structured telephone interview. The ethical issues pertaining to collection of audit data using the telephone interview are discussed.

Clinical Nursing Research↗
PubMed2003

Adherence to diabetes control recommendations: impact of nurse telephone calls.

BACKGROUND: Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications. AIM: The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin (HbA1c) levels and adherence to diabetes control recommendations. METHODS: A randomized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls. Twenty patients were randomly assigned to an intervention group and 16 to a control group. The goal of the intervention was to keep blood glucose concentrations close to the normal range (HbA1c < 7%). The intervention was applied to the intervention group for 12 weeks, and consisted of continued education and reinforcement of diet, exercise, medication adjustment recommendations, as well as frequent self-monitoring of blood glucose levels. Telephone intervention was performed twice per week for the first month and then weekly for the second and third month. Participants were requested to write self-management logs including blood glucose levels, diet and an exercise diary. A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail. All medication adjustments were communicated to participants' doctors. The HbA1c and diabetes adherence were measured before and after the intervention. RESULTS: Patients in the intervention group had a mean decrease of 1.2% in HbA1c levels and those in the control group had a mean increase of 0.6% in HbA1c levels. The intervention group had greater diet and blood glucose testing adherence than the control group. CONCLUSION: These findings indicate that a nurse telephone intervention can improve HbA1c, and diet and blood glucose testing adherence.

Blood Glucose↗
PubMed2003

Telephone use among noninstitutionalized persons with dementia living alone: mapping out difficulties and response strategies.

The aim of this study was to map out and describe difficulties and response strategies in telephone use among elderly, noninstitutionalized persons with dementia living alone. To obtain explorative data, interviews and observations in the homes were undertaken with 10 participants diagnosed with dementia. The participants were observed when showing their telephones, calling a well-known number, responding to a request previously sent by letter to make a telephone call, and finding a number in the telephone directories. The data were analysed using a comparative approach, and resulted in descriptive categories. The participants' difficulties were categorized as difficulty in 'knowing what', 'knowing where', 'knowing how' and overcoming motor, perceptual, verbal and environmental obstacles. In responding to these, they used a variety of environmentally related strategies such as using perception or habits and habitual places, verbalizing aloud, seeking help from others, and adjusting the physical environment. They also used a few cognitively related strategies such as repeating and stopping and reflecting. Overall, difficulties were frequent and common, and the effectiveness of the strategies was questionable. The results indicate that it might be unrealistic to assume that elderly persons with symptoms of dementia who live alone are able to satisfactorily use the telephone for safety, communication and participation in society.

Activities of Daily Living↗
PubMed2002

Volume and nature of telephone calls in a specialty headache practice.

BACKGROUND: No information exists regarding the contribution of patient-related telephone calls to the burden of headache practice. OBJECTIVE: To identify the nature and volume of patient-related telephone calls to a specialty headache practice over a 1-month period. DESIGN AND METHODS: The characteristics of all patient-related calls to a single headache practitioner occurring during July 2001 were documented. Information was obtained on the caller, reason for call, length of call, timing and day of call, stated importance of call, patient's principal headache diagnosis, and principal comorbid psychiatric disorder, if any. RESULTS: One hundred sixty-five outpatient headache-related calls were received in July 2001, 3.17 for every hour of headache clinic scheduled. A total of 65% of all calls was generated by just 36% of callers. Of the 32 patients who placed more than one call during the study period, 50% had chronic daily headache, 53% had a personality disorder, and 38% had both. Twenty-seven percent of all calls were placed by someone other than the patient, 58% involved requests for medication refills, and 17% reported a new symptom or medication side effect. Over half of all calls were placed on Mondays and Tuesdays. Relatively few occurred outside work hours; 18% of calls characterized as "emergency" and 36% of calls characterized as urgent involved requests for controlled substances. Most of these calls were placed by patients with personality disorders. None of the 11 calls characterized as emergency calls was judged so by the physician; only 19% of the urgent calls were judged so by the physician. CONCLUSIONS: Telephone calls contribute substantially to the burden of caring for patients in a specialty headache practice. Patients with chronic daily headache and personality disorders contribute disproportionately to this telephone burden. Efforts to identify such patients at presentation and educate them regarding appropriate telephone use seem to be warranted.

Ambulatory Care Facilities↗
PubMed2001

In-vivo testing of digital cellular telephones in patients with implantable cardioverter-defibrillators.

AIMS: To investigate the susceptibility of implantable cardioverter defibrillators to electromagnetic interference generated by digital cellular telephones, functioning in both international transmission technologies: the Global System for Mobile Communication (GSM) and the Digital Cellular System (DCS 1800). METHODS AND RESULTS: In 36 patients with transvenous implantable cardioverter defibrillators from two manufacturers (Medtronic and Guidant/CPI), cellular telephones with different levels of minimal and maximal power output were tested in the transmitting and receiving mode. Evaluation was performed in activated implantable defibrillators during spontaneous cardiac activity and continuous VVI or DDD pacing to assess possible electromagnetic interference. In two patients, appropriateness of ventricular fibrillation detection and therapy was judged during telephone testing. There was no damage, reprogramming, inappropriate shock therapy or pacing inhibition during the tests. In seven pre-pectoral Medtronic implantable defibrillators, transient electromagnetic interference caused 19 erroneous sensing events, when the operating phone was held in close vicinity to the programmer head. These 'pseudo-oversensing' events, which did not result in logging of arrhythmia episodes in the device counter, were interpreted as an adverse interaction between the telephone and the programming device. CONCLUSION: Digital cellular telephones do not represent a risk to Medtronic and Guidant/CPI recipients of the specific implantable defibrillator models herein tested.

Defibrillators, Implantable↗
PubMed2003

Randomized Trial of Telephone Intervention in Chronic Heart Failure (DIAL): study design and preliminary observations.

BACKGROUND: In the last few years different approaches based on comprehensive patient care and close surveillance by multidisciplinary teams have shown promising results in heart failure. However, current evidence mainly derives from small and often nonrandomized studies performed at a single center, with selected populations, using dissimilar and complex strategies. We designed a large randomized study to test the hypothesis that a single program, based on a centralized telephone intervention performed by trained nurses, could reduce morbidity and mortality in chronic heart failure. METHODS: The Randomized Trial of Telephone Intervention in Chronic Heart Failure (DIAL) is a randomized, controlled, open trial designed to compare frequent telephone follow-up intervention versus control. We enrolled 1518 patients with stable chronic heart failure and optimal treatment from 51 centers in Argentina. DIAL trial intervention strategy is based on frequent telephone follow-up provided by nurses trained in heart failure and performed from a single surveillance center, assuring a homogeneous and high quality intervention. The primary objective is to determine the effect of the intervention as compared with the usual follow-up on the combined endpoint of all-cause mortality or hospitalization for worsening heart failure. The objectives of the intervention are education, counseling, and monitoring to enhance self-control mechanisms, timely medical visits, diet, and drug therapy compliance. Telephone call frequency was determined according to preestablished criteria of clinical status severity assessed at each phone contact. The study ended in August 2002. CONCLUSION: The results of this study may provide information about mortality, hospitalizations, and quality of life contributing to set standards for management programs in the current treatment of chronic heart failure.

Female↗
PubMed2005

[The reliability of the german version of the barthel-index and the development of a postal and telephone version for the application on stroke patients].

BACKGROUND AND PURPOSES: Aim of the study was to translate the original version of the Barthel-Index (BI) into German and to investigate the reliability of the German version. In addition, a German version of the BI for postal and telephone use was developed. METHODS: Data were collected in four neurological hospitals in Germany. The translation of the BI followed the protocol of the Medical Outcomes Trust. The interrater reliability of the German version of the BI was investigated in 72 patients after acute stroke. The reliability of the postal and telephone version of the BI was compared with face-to-face interview in 147 patients three months after stroke. Reliability was assessed using simple weighted kappa-statistics. RESULTS: The interrater reliability of the German version of the BI was excellent (mean kappa 0.93). The mean kappa coefficient was 0.79 for the postal version of the BI and 0.80 for the telephone version. Thus, the agreement between the postal and the telephone administration of the BI compared to the face-to-face interview was substantial to excellent. CONCLUSIONS: Our study published the first German version of the BI which was investigated for interrater reliability in a standardized way. The development of a postal and a telephone version allows the widespread use of the German BI for the follow up of stroke patients in different access paths.

Acute Disease↗
PubMed1997

[The reliability of a new 12-channel ECG with telephone transmission].

BACKGROUND AND OBJECTIVE: Different from the situation in the USA, Canada, Israel, Italy and Great Britain transmission of electrocardiograms (ECG) by telephone plays an unimportant part in Germany because existing technology is at best adequate for the diagnosis of arrhythmias. A new simple system, the size of a mobile phone (P12, Aerotel, Israel), was tested: for the first time in Europe it allows patients themselves to obtain a 12-lead ECG and transmit it via any telephone to a centre for analysis. This system was evaluated for its reliability when used by lay persons. PATIENTS AND METHODS: Qualitative and quantitative parameters of a conventional 12-lead ECG obtained in 217 patients (86 women, 131 men) were compared with those of 12-lead ECGs recorded and stored by lay persons, transmitted via telephone to a computer and then printed out. RESULTS: All ECGs transmitted with the P12 were analysable: quality was good or very good in 86%. Heart rate, transmission time and the various durations agreed with the conventional leads, while P12 underregistered amplitudes by about 15%. This difference was correctable by a constant or by adjusting the ECG machine. Atrial fibrillation (in eight of eight cases), infarct changes (40 of 40), ST elevations or depressions (15 of 15) and T negativities (80 of 82) were also reliably recognized. CONCLUSIONS: The described method proved simple and reliable. Clinically significant information in the ECG can be transmitted within minutes and with high diagnostic reliability to a central station via any telephone. P12 is thus suitable for self-recording of ECGs by patients with potentially dangerous cardiac conditions. However a centre with cardiologically trained personnel should be available where telephone transmission of the ECGs and dialogue with the patients is possible around the clock.

Electrocardiography↗