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PubMed2006

A qualitative study examining tensions in interdoctor telephone consultations.

OBJECTIVE: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight. The interdoctor telephone consultation is a common health care setting in which health professional communication skills are exercised. Breakdowns in this communication commonly occur and, surprisingly, this skill is not formally addressed in medical training. This study sought to clarify the communication issues that can occur during interdoctor telephone consultations in order to inform future educational initiatives in this domain. METHODS: Data were collected and triangulated among 3 sources: documentation of 129 telephone consults received; 51 hours of field observations of consultants, and semi-structured interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methodology. RESULTS: Overwhelmingly, participants described tensions with telephone consultation communication. Recurrent theme analysis revealed 5 key sources of tension: discursive features; context; fragmented clinical process; reason for call, and responsibility. Often, callers and consultants viewed similar instances in different and opposite manners, contributing to difficulties in the exchange. Further, a vicious cycle in which a participant's strategies to mitigate tension actually increased tension for the other participant was identified. CONCLUSIONS: Interdoctor telephone consultation has become an integral part of medical practice; however, tensions within this exchange can undermine its effectiveness. The results of this study provide a preliminary theory upon which an educational intervention to improve this communication skill can be based.

Communication↗
PubMed2005

A randomized trial of regular standardized telephone contact by a diabetes nurse educator in adolescents with poor diabetes control.

OBJECTIVE: The aim of this study was to determine the effect of regular standardized telephone contact by a diabetes nurse educator (DNE) on metabolic control, treatment compliance, and quality of life in adolescents with poorly controlled type 1 diabetes. METHODS: A single-blinded 6-month randomized controlled trial was used. Participants included 46 of 49 eligible adolescents (13-17 yr) with type 1 diabetes >1-yr duration and hemoglobin A1c (HbA1c) >8.5% for the previous 6 months. Subjects were randomly assigned to 6 months of standard diabetes management or standard care plus weekly telephone contact by a DNE. Telephone conversations included review of events in the adolescents' lives and diabetes education, but the primary focus was on blood glucose results and insulin-dose adjustments. HbA1c, compliance with glucose monitoring, quality of life [Diabetes Quality of Life Scale for Youth (DQOLY)], and family functioning [Family Environment Scale (FES)] were assessed at baseline, and at 3 and 6 months. Posthoc, HbA1c levels were assessed 6 months following study completion. RESULTS: Six months of regular telephone contact by a DNE had no immediate effect on any of the outcome measures. However, posthoc 6 months, HbA1c levels decreased (1% change compared to baseline) in 6/21 of the study group and 0/18 of the control group, while HbA1c increased in 4/21 of study subjects compared to 8/18 of control subjects (p = 0.015). CONCLUSIONS: In contrast to adult studies, regular telephone contact did not lead to immediate improvements in metabolic control in adolescents with poorly controlled type 1 diabetes. However, knowledge and skills gained during the intervention may have had a delayed beneficial effect in these high-risk adolescents.

Adolescent↗
PubMed1998

Long-term reliability and validity of alcoholism diagnoses and symptoms in a large national telephone interview survey.

The long-term reliability and validity of telephone lay interview assessments of alcoholism were examined in the context of a large national community-based survey of over 8,000 male Vietnam era veterans. A subsample of 146 men was interviewed twice by telephone using the same structured interview an average of 15 months apart to evaluate the long-term reliability of alcoholism symptoms and diagnoses. In addition, a search of Department of Veterans Affairs patient treatment files of inpatient hospitalizations between 1970 and 1993 yielded a subsample of 89 interviewed men with a past discharge diagnosis of alcohol dependence. The test-retest reliability of alcohol abuse and alcohol dependence diagnoses was good, with kappa coefficients of 0.74 and 0.61, respectively. The reliability of individual alcoholism symptoms was fair to good, with kappas of 0.46 to 0.67. Ninety-six percent of individuals identified by Department of Veterans Affairs patient treatment files as having an alcohol dependence diagnosis were correctly diagnosed by the telephone interview. The results of the present study provide additional evidence for the long-term reliability and validity of lifetime alcoholism diagnoses, and suggest that the reliability and validity of telephone interview assessments of alcoholism are as good as that of an in-person interview. Telephone administration of structured psychiatric interviews appears to be an attractive alternative to in-person interviewing for gathering information about alcoholism and alcohol-related problems.

Adult↗
PubMed1996

Electromagnetic interference of analog cellular telephones with pacemakers.

The aim of this study was to verify whether there is a public health risk from the interference of analog cellular telephones with pacemakers. We used a human trunk simulator to reproduce an actual implant, and two cellular telephones working with the TACS (Total Access Communication System) standard. Results showed that the electromagnetic field radiated from the analog cellular telephones interfered with a large number of the pacemakers tested (10/25). When the telephone antenna was in close proximity to the pacemaker head, pacemaker desensitizing and sensitizing and pulse inhibition was detected at the moment of an incoming call and throughout ringing. In the worst case of pulse inhibition, the pacemaker skipped three nonconsecutive beats and then resumed its normal pacing, while the desensitizing and sensitizing phenomena persisted as long as the interfering signal was on. Pulse inhibition was also observed when the connection did not succeed. Maximum sensing threshold variation was about 186% (increase) and 62% (decrease) for desensitizing and sensitizing phenomena, respectively. It was also demonstrated that the signal emitted by analog cellular telephones during the crossing of contiguous cells could induce pacemaker pulse inhibition, but under our experimental conditions this event did not seem to pose a risk for the pacemaker patient.

Electromagnetic Fields↗
PubMed1996

The safety of digital mobile cellular telephones with minute ventilation rate adaptive pacemakers.

In vitro tests suggest that rate adaptive pacemakers using changes in transthoracic impedance to vary pacing rate may be affected by digital mobile telephones. Electromagnetic fields generated by digital mobile telephones (Global System for Mobile [GSM]) represent a potential source of electromagnetic interference (EMI) for the Telectronics META rate adaptive pacemakers, which use transthoracic impedance as a sensor to determine changes in minute ventilation. Sixteen implanted Telectronics META pulse generators were exposed to 25-W simulated GSM transmissions (900-MHz carrier pulsed at 2, 8, and 217 Hz with a pulse width of 0.6 ms) and the antenna of a 2-W digital mobile telephone (900-MHz, 217-Hz pulse, 0.6-ms pulse width). The 12 dual and four single chamber devices were programmed to maximum sensitivity and assessed in unipolar and bipolar settings and rate adaptive and nonrate adaptive modes. In all cases of EMI, testing was repeated at lower, more routinely set bipolar sensitivity levels. At maximum sensitivity, 11 of 16 devices displayed no evidence of EMI. Brief ventricular triggering occurred in 2, a brief pause in 1, a combination of both in 1, and a brief episode of pacemaker-mediated tachycardia in 1. With pulse generators programmed to more routine sensitivities, only one device displayed rare single beat ventricular triggering. No changes in minute ventilation rate adaptive pacing were observed. At maximum unipolar sensitivities, the META series of rate adaptive pacemakers are resistant to clinically important EMI from digital mobile telephones. Set at routine sensitivities, these devices perform reliably in the presence of digital mobile telephones.

Cardiography, Impedance↗
PubMed2005

Oral injuries in children: comparison of those children who visit and do not visit the after-hours clinic after telephone consultation.

Pediatric patients who sustain oral and dental injuries during the evening or night require telephone consultation and/or examination at our regional medical center in the oral surgery clinic. Between April 1, 2001 and March 31, 2003, a total of 393 patients (1-15 years old) sought advice; 67.7% came for a visit and examination after telephone consultation (visited patients) and 32.3% received telephone advice, but did not need to come for a medical visit (non-visited patients). The busiest consulting time for both groups was the evening time band. Soft tissue injuries were the most frequent in both visited and non-visited patients, 66.9 and 85.0% respectively. Particularly in non-visited patients, the upper lip was the most significantly affected site (57.4%). The most common cause of injuries was falls (84.2% of visited and 77.2% of non-visited patients). Of non-visited patients, the most common reason not to visit was a minor injury that did not require examination (87.4%). We recommend that a personal telephone call from a dentist is important because telephone consultation can help triage patients and provide relief for the patient's guardians.

Accidental Falls↗
PubMed2001

Nurse practitioner patient centered telephone calls in a VA primary care geriatric clinic.

PURPOSE: To present original research of a retrospective study of telephone calls by nurse practitioners (NP) to geriatric primary care patients over the period of one year in a Veteran's Administration primary care clinic in the southeast. DATA SOURCES: A convenience sample of the electronic patient progress notes labeled "telephone call" of three full time NPs was collected from May 1, 1998 through April 31, 1999. A total of 1,541 unique telephone calls made by NPs to patients were examined. CONCLUSIONS: Patient telephone calls consume work time, which is often hidden and uncounted when examining time spent with patients. Most calls (62%) were generated by others; the remainder (38%) were initiated by the NPs. The greatest number (42%) of requests related to medication refills. IMPLICATIONS FOR PRACTICE: Many patients requested to talk to the NP for non-clinical issues; many of the requests could have been handled by other staff. It is as if the patient no longer has the traditional call bell to call the nurse but now has the telephone to call the NP. The personal aspect of the phone call may be what is needed by some of the patients looking for a form of human contact.

Aged↗
PubMed1993

Telephone advice in the accident and emergency department: a survey of current practice.

The objective of this study was to assess the standard of advice given by telephone by accident and emergency (A&E) departments following patients' enquiries. In order to do this patient enquiries were simulated and a telephone questionnaire was carried out. The study was carried out in 18 major and 16 minor A&E departments in Wales. Results achieved were that overall, correct telephone advice was given to 72 of 97 simulated patients (74%). Sixty calls were dealt with by the nursing staff (62%) who gave correct advice on 41 (68%) occasions. No A&E department had a formal policy nor provided staff training for handling patients' enquiries by telephone. It is concluded that A&E departments should train designated members of staff, preferably the triage nurse, who would formally deal with telephone enquiries requiring medical advice. There should be formal documentation of the enquiry and advice proffered as part of a departmental policy.

Counseling↗
PubMed2000

Next day telephone follow up of the elderly: a needs assessment and critical incident monitoring tool for the accident and emergency department.

BACKGROUND: Patients over the age of 75 years comprise an increasing proportion of accident and emergency (A&E) department attendances. Within this group there is a high incidence of comorbidity, which mandates effective discharge coordination from the A&E department. OBJECTIVES: The aims of this study were to assess the needs of these patients the day after discharge, target patients for appropriate interventions and identify critical incidents. SETTING: The study was undertaken in a district general hospital A&E department that has 62000 new patient attendances per year. INCLUSION CRITERIA: Patients aged 75 years or over who were discharged from the A&E department. EXCLUSION CRITERIA: Nursing home patients. Patients without a telephone. STUDY DESIGN: Pre-discharge information was collected from the medical notes. A community liaison nurse (CLN) then contacted patients by telephone. A semistructured questionnaire was used to assess patients. Patients were risk stratified and appropriate interventions made. Interventions initiated by the CLN were scored from 1 to 6 based on the level of input required. RESULTS: 551 patients or their carers were contacted by telephone. Existing home support was felt to be insufficient in 44 (8%) cases and in need of immediate intervention in a further 45 (8%) cases. Sixty five (11%) Category 1 patients required no intervention, 223 (42%) Category 2 patients required advice only, 107 (19%) Category 3 patients were referred to their GP, 127 (23%) Category 4 patients required a domicillary visit by a GP or a nurse, 26 (5%) Category 5 patients were at risk requiring urgent home assessment and three Category 6 patients had to re-attend A&E. Advice was given by the CLN on a broad range of issues and a wide range of health care services was accessed. Five hundred and fifty nine referrals were made by the CLN after telephone assessment. CONCLUSIONS: Telephone follow up of patients over 75 attending our A&E department identified a number of areas where care could be improved before and after discharge. This low cost, high quality intervention has the potential for decreasing inappropriate return visits to the department by a vulnerable group of patients as well as improving overall quality of care.

Aged↗
PubMed2004

Retrospective study into the delivery of telephone cardiopulmonary resuscitation to "999" callers.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is an essential part of the chain of survival, with early administration directly affecting the patient's chance of survival. Pre-arrival telephone CPR instructions provide callers who have no CPR training on how to undertake this intervention. With the emergency medical dispatcher unable to see the caller or the patient, it is possible that problems will arise, presenting barriers, that stop the caller undertaking effective CPR. OBJECTIVE: To examine how commonly barriers to telephone CPR occur and whether this affects the time it takes to perform the intervention. METHOD: A retrospective quantitative analysis was undertaken using a convenience sample of 100 emergency calls. Calls were identified in the emergency control room as cardiac arrests and confirmed by the responding paramedics as cardiac arrests. The calls were listened to, established if CPR instructions were given, if the instructions were followed, if anything hindered the instructions undertaken, and the time taken to reach key points. FINDINGS: 18 cases had bystander CPR administered. An additional 56 of cases had CPR instructions provided but "barriers" in 49% (n = 27) hindered the effectiveness of these. The median time to recognition of cardiac arrest was 40 seconds, with time to first ventilation being 4 min 10 s and time to first compression 5 min 30 s. These times were notably higher in those cases where a barrier to effective telephone CPR existed. CONCLUSIONS: Barriers to undertaking telephone CPR occurred with a high degree of frequency. These barriers affect the ability of the caller to perform rapid and effective telephone CPR.

Cardiopulmonary Resuscitation↗
PubMed2006

Understanding reasons for asthma outpatient (non)-attendance and exploring the role of telephone and e-consulting in facilitating access to care: exploratory qualitative study.

OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews. SETTING: Hospital outpatient clinic in West London. PARTICIPANTS: Nineteen patients with moderate to severe asthma (12 "attenders" and 7 "non-attenders"). RESULTS: Patients' main reasons for attending were the wish to improve control over asthma symptoms and a concern not to jeopardise the valued relationship with their doctor. Memory lapses, poor health, and disillusionment with the structure of outpatient care were important factors implicated in non-attendance. The patients were generally sceptical about the suggestion that greater opportunity for telephone consulting might improve access to care. They expressed concerns about the difficulties in effectively communicating through non-face to face media and were worried that clinicians would not be in a position to perform an adequate physical examination over the telephone. Email and text messaging were viewed as potentially useful for sending appointment reminders and sharing clinical information but were not considered to be acceptable alternatives to the face to face clinic encounter. CONCLUSIONS: Memory lapses, impaired mobility due to poor health, and frustration with outpatient clinic organisation resulting in long waiting times and discontinuity of care are factors that deter patients from attending for hospital asthma assessments. The idea of telephone review assessments was viewed with scepticism by most study subjects. Particular attention should be given to explaining to patients the benefits of telephone consultations, and to seeking their views as to whether they would like to try them out before replacing face to face consultations with them. Email and text messaging may have a role in issuing reminders about imminent appointments.

Adult↗
PubMed1988

Acoustic trauma caused by the telephone. Report of two cases.

Two patients with acoustic trauma resulting from the use of telephones have been evaluated. Both patients used a particular type of telephone which had the ringing device located in the ear receiver and no automatic gain control in the circuit. The output of the bell recorded on one of these telephones was in the 139-dB range on the A scale. The auditory insult resulted, in the case involving a cord-type telephone, from the transmission of a loud, extraneous sound probably due to a misfunction of the circuit and, in the second case, from the patient holding his cordless telephone against his ear when ringing occurred.

Female↗
PubMed2006

Randomized trial of a telephone care management program for outpatients starting antidepressant treatment.

OBJECTIVE: This study evaluated the effectiveness of a structured telephone-based care management program for patients in a prepaid health plan receiving new antidepressant prescriptions from psychiatrists. METHODS: Potential participants were identified with computerized medical records and contacted by telephone. Eligible and consenting participants were randomly assigned to continued usual care (N=104) or to a three-session telephone care management program (N=103). Care management contacts included assessment of depressive symptoms, medication adherence, and medication side effects with structured feedback to treating psychiatrists. Effectiveness was assessed three and six months after randomization by blinded telephone assessments (depression scale on the Hopkins Symptom Checklist [SCL] and patient-rated global improvement). Computerized records were used to assess medication adherence and frequency of in-person follow-up visits. RESULTS: Compared with usual care, the care management intervention had no significant effect on the mean score of the SCL depression scale at six months, on the probability of 50 percent improvement in depressive symptoms (41 percent for care management and 37 percent for usual care), or on the probability of patient-rated improvement (57 percent for care management and 52 percent for usual care). Patients assigned to care management made significantly more medication management visits over six months (2.4 visits compared with 2.0 visits; p=.035), but there were no significant differences in rates of adequate medication treatment. CONCLUSIONS: This study found that a low-intensity telephone care management program did not appear to significantly improve clinical outcomes for patients starting antidepressant treatment. Compared with findings from earlier primary care studies, this study found that patients receiving care from a psychiatrist received more intensive treatment, although many still experienced poor outcomes.

Adult↗
PubMed2003

Analysis and psychotherapy by telephone: twenty years of clinical experience.

Psychoanalysis via telephone is becoming increasingly prevalent while remaining an area of comparatively little study. The author's early telephone treatment of a series of patients living some distance away or engaged in business travel, and his subsequent telephone treatment of nine analytic and five psychotherapy patients following his own geographic move, are discussed in detail. The mechanics of beginning and carrying out such treatment are examined. The theoretical implications of the shift to the telephone and the ambivalence with which it is often met by clinicians are also explored. The role of nonverbal communication in both in-person and telephone analysis is considered, as is the concept of the analytic office as a literal space and a psychological container. Suggestions for future research are advanced.

History, 20th Century↗
PubMed1983

The telephone in pediatric medicine. A review.

From a review of numerous studies and reports of management of pediatric illness by telephone, it is concluded that innovative methods of teaching effective diagnosis and management by telephone still need to be explored. More research should be done on patient outcomes to assess the adequacy of the initial decision-making process, rather than relying solely on the number of questions asked. This will necessitate studies using actual patient telephone vignettes rather than simulated ones. Finally, research needs to be done on the efficacy of the "telephone hour" used by many physicians to manage their day more efficiently. Such studies could compare patient outcome and parent and physician satisfaction, in practices where the "telephone hour" is standard, to those practices where patient calls are managed as they occur.

Diagnosis↗
PubMedDate not supplied

Telephone communications between diabetes clients and nurse educators.

The purpose of this study was to describe the use of telephone communications between diabetes nurse educators (DNEs) and their clients with diabetes. A questionnaire was designed to examine the use of the telephone with diabetes clients from the perspective of DNEs. A total of 465 DNEs across the US were selected using a systematic sample from the membership directory of the American Association of Diabetes Educators. A total of 247 were questionnaires completed and returned (55%). Ninety-one percent of DNEs reported using the phone with clients and averaged 15 phone calls per week. Over 90% frequently reported discussing the following topics with clients: home blood glucose monitoring, hyperglycemia, hypoglycemia, insulin use, and diet. Analysis of telephone users showed that DNE experience and diabetes educator certification were significant factors in the differences observed in the reported topics discussed over the telephone. These findings suggest the need for guidelines for telephone contact with diabetes clients.

Adult↗
PubMed1995

Reliability of the Blessed Telephone Information-Memory-Concentration Test.

In-person cognitive evaluations can be costly and labor intensive in geographically widespread populations. Reliable telephone instruments that screen for cognitive status would greatly facilitate epidemiologic and other longitudinal studies. We evaluated the reliability of the Blessed Information-Memory-Concentration (IMC) test when administered by telephone. Eighty-four subjects with a wide range of cognitive abilities were administered the Blessed IMC twice over a 3-week interval. Forty-nine of the subjects were administered the test both by telephone and in-person, and 35 of the subjects were tested twice by telephone. Spearman's rank correlation was used to compare scores of the different administrations (.96; P < .001) and to examine test-retest reliability (.96; P < .001). The Blessed Telephone IMC (TIMC) test exhibits excellent reliability both when compared to in-person administration as well as in test-retest results. The Blessed TIMC appears to be a practical instrument for population and longitudinal studies when in-person assessment is not feasible.

Aged↗
PubMed2000

Visualism in community nursing: implications for telephone work with service users.

This article explores the potential effects of visualism (a prejudice in favor of the seen) on the perceived legitimacy of telephone work in community nursing. It discusses data from an exploratory study on telephone work, which used guided interviews with a purposive sample of 14 community nurses. Interviewees expressed both positive and negative ideas about telephone work and had particular concerns about the assessment of people, context, problems, and comprehension by telephone. These issues are discussed with reference to publications on visualism, metaphor, communication, and nursing work. The authors conclude that an awareness of the possible effects of visualism on ideas and practice could lead to improvements in both communication and assessment, whether carried out by telephone or face to face.

Attitude of Health Personnel↗