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PubMed2001

Telephone versus mail interventions for maintenance of physical activity in older adults.

Although telephone and mail are often used to promote physical activity adoption, their ability to produce long-term maintenance is unclear. In this study, 140 men and women aged 50-65 years received 1 year of telephone counseling to adopt higher (i.e., more vigorous) versus lower intensity (i.e., moderate) exercise. After 1 year, participants were rerandomized to a 2nd year of contact via (a) telephone and mail or (b) predominantly mail. Participants who were prescribed higher intensity exercise and received predominantly mail had better exercise adherence during the maintenance year than those who received telephone and mail. Both strategies were similarly effective in promoting maintenance in the lower intensity condition. Results suggest that after successful adoption of physical activity with the help of telephone counseling, less intensive interventions are successful for physical activity maintenance in older adults.

Aged↗
PubMed2002

[The use of telephone for counseling diabetic patients: a descriptive and pedagogic approach].

This descriptive study of telephone interviews, conducted between the staff of a diabetes unit and patients, is intended to clarify a professional manner in which the telephone should be used as part of patient care. Having examined simulated calls from diabetic patients, analysis of the interviews conducted by the doctors, nurses and members of the office staff in a hospital unit demonstrates wide differences in the content, the quality of the content, and the interview strategy. An interpretation of the results signals the importance of the manner in which the staff member answers, a knowledge of patients' genuine needs, and an ability to adequately acknowledge the emotional state of the patient. Structuring telephone conversations, allowing sufficient time for patient responses, avoids over-long interviews. The decisions taken by the staff member answering the call, in terms of advice and suggestions of actions to take, must be systematically backed-up by ensuring that the patient has properly understood what has been said. The study poses a number of questions, notably concerning the specific requirements demanded by these new remote-care services in the organization of care within a hospital unit, and the professional approach to the use of the telephone as part of the relationship with patients. Recommendations are given concerning the general principles governing a telephone interview and the definition of training objectives for healthcare professionals.

Counseling↗
PubMed2002

[Do mobile telephones have adverse effects on the functions of implantable cardioverter defibrillators?].

OBJECTIVE: The aim of this study was to investigate the effects of widely used mobile telephones on the functions of implantable cardioverter-defibrillators (ICD). METHODS: The study included 9 patients (2 women, 7 men, mean age 65.5 +/- 6) with coronary artery disease who had underwent transvenous ICD implantation due to sustained ventricular tachycardia and/or fibrillation. First the test was performed on the basal conditions of ICD. Then, spontaneous heart rate of the patient was programmed to 10 beats/minute on VVI mode and the test was repeated. Two mobile telephones were located symmetrically 50 cm, 30 cm, 20 cm and 10 cm away from the ICD pocket in the pectoralis muscle and finally the mobile telephones antennas were touched to the pockets. On these different distances, the test was repeated during opening, standby, calling, talking and closing of the telephones. Possible ICD dysfunctions such as improper antitachycardic shock, inhibition of pacemaker functions, conversion to ventricular asynchronous mode (VOO) and development of ventricular trigger in devices with two chamber pacemaker functions were tested. The changes were observed on intracardiac and surface ECG's. RESULTS: There were no changes in the basal and pacemaker functions of ICD's and no symptoms in any patients. CONCLUSION: We have concluded that mobile telephones have no adverse effects on the functions of types of ICD assessed in the study.

Aged↗
PubMed2002

Problem solving by telephone in palliative care: use of a predetermined assessment tool within a program of home care technology.

In the Rotterdam Cancer Institute, nurses from the palliative care unit take care of accessibility outside office hours for patients transferred home with technical equipment for symptoms control. The nurses use a predetermined assessment tool (PAT) for handling telephone calls. A retrospective evaluation on the registration forms used over the years 1997-1999 was performed to evaluate the telephone service. A total of 124 patients in need of technical support was transferred from the hospital during the study period: 52 in 1997, 33 in 1998, and 39 in 1999. Over the years, 157 calls were registered from 64 (52%) patients. In 1997, the majority of the calls (73%) came from the patient or the family. The frequency of calls from the general practitioner did not change, but calls from the district nurse increased from 12% in 1997 to 35% in 1998, and 48% in 1999. Professionals working in nursing homes have used the telephone service since 1998. The reasons for calling were pain (40%), symptoms other than pain (19%), technical problems (33%), general information and advice (6%), and logistic problems (2%). In 152 of the 157 telephone calls (97%), problems could be solved without admission. The mean time to answer a call was 16 minutes. The telephone service and the use of the PAT made it possible to solve 97% of problems without admission.

Adult↗
PubMed2002

Boosting uptake of influenza immunisation: a randomised controlled trial of telephone appointing in general practice.

BACKGROUND: Immunisation against influenza is an effective intervention that reduces serologically confirmed cases by between 60% and 70%. Almost all influenza immunisation in the UK is done within general practice. Current evidence on the effectiveness of patient reminders for all types of immunisation programmes is largely based on North American studies. AIM: To determine whether telephone appointments offered bygeneral practice receptionists increase the uptake of irfluenza immunisation among the registered population aged over 65 years in east London practices. DESIGN OF STUDY: Randomised controlled trial. SETTING: Three research general practices within the East London and Essex network of researchers (ELENoR). METHOD: Participants were 1,820 low-risk patients aged 65 to 74 years who had not previously been in a recall system for influenza immunisation at their general practice. The intervention, during October 2000, was a telephone call from the practice receptionist to intervention group households, offering an appointment for influenza immunisation at a nurse-run. clinic Main outcome measures were the numbers of individuals in each group receiving immunisation, and practice costs of a telephone-appointing programme. RESULTS: intention to treat analysis showed an immunisation rate in the control group of 44%, compared with 50% in the intervention group (odds ratio = 1.29, 95% confidence interval = 1.03 to 1.63). Of the patients making a telephone appointment, 88% recieved immunisation, while 22% of those not wanting an appointment went on to be immunised. In the controlgroup, income generated was 11.35 pounds per immunisation, for each additional immunisation in the intervention group the income was 5.20 pounds. The 'number needed to telephone' was 17. CONCLUSION: Uptake of influenza immunisation among the low-risk older population in inner-city areas can be boosted by around 6% using a simple intervention by receptionists. Immunisation rates in this low-risk group fell well short of the 60% government target. Improving immunisation rates will require a sustained public health campaign. Retaining the item-of-service payments to practices should support costs of practice-based interventions.

Aged↗
PubMed2002

[Prior use of a telephone-nursing triage service by patients of emergency services].

OBJECTIVES: A province-wide telephone-nursing triage service was implemented in Quebec, Canada, in order, among other objectives, to decrease overcrowding in hospital emergency rooms. This study analyses prior use of Info-Sante CLSC telephone service by patients of emergency services. METHODS: Structured interviews were conducted with 850 patients of a general hospital emergency room and of walk-in medical clinics. Patients were recruited while waiting to see the physician between 8h and 23 h, 7 days a week, from November 1997 to June 1998. Information was collected on knowledge and use of the telephone-nursing triage service, health problem and perceived health status, information-seeking behaviour on health services, utilisation habits, social support, and socio-demographic characteristics. Interval estimates and multiple logistic regressions were performed. RESULTS: Of the patients who were aware of this service, 17,4% (CI(95)=0,14 - 0,20) had used it prior to their medical visit. Among these, 85,1% had received a recommendation to consult a doctor. Among the users who were at the hospital emergency room at the time of the study, 56,4% were advised to consult a walk-in clinic or a CLSC, 28,2% their family doctor and only 12,8% a hospital emergency room. The probability of prior recourse to the telephone nursing service is influenced significantly by the duration of the health problem (2-4 days versus<2 days: OR(adjusted)=2,03), new health problem (OR(adjusted)=1,98) and by the frequenting of walk-in clinics rather than hospital emergency rooms (OR(adjusted)=0,31). CONCLUSION: Despite a heightened awareness of the telephone-nursing triage service, few users of emergency services make use of it and, when they do, follow rather loosely the recommendation towards the type of service judged appropriate for their needs.

Adult↗
PubMed2003

Further aspects on cellular and cordless telephones and brain tumours.

We included in a case-control study on brain tumours and mobile and cordless telephones 1,617 patients aged 20-80 years of both sexes diagnosed during January 1, 1997 to June 30, 2000. They were alive at the study time and had histopathology verified brain tumour. One matched control to each case was selected from the Swedish Population Register. The study area was the Uppsala-Orebro, Stockholm, Linköping and Göteborg medical regions of Sweden. Exposure was assessed by a questionnaire that was answered by 1,429 (88%) cases and 1,470 (91%) controls. In total use of analogue cellular telephones gave an increased risk with odds ratio (OR)=1.3, 95% confidence interval (CI)=1.04-1.6, whereas digital and cordless phones did not overall increase the risk significantly. Ipsilateral use of analogue phones gave OR=1.7, 95% CI=1.2-2.3, digital phones OR=1.3, 95% CI=1.02-1.8 and cordless phones OR=1.2, 95% CI=0.9-1.6. The risk for ipsilateral use was significantly increased for astrocytoma for all studied phone types, analogue phones OR=1.8,95% CI=1.1-3.2, digital phones OR=1.8, 95% CI=1.1-2.8, cordless phones OR=1.8, 95% CI=1.1-2.9. Use of a telephone on the opposite side of the brain was not associated with a significantly increased risk for brain tumours. Regarding anatomical area of the tumour and exposure to microwaves, the risk was increased for tumours located in the temporal area on the same side of the brain that was used during phone calls, significantly so for analogue cellular telephones OR=2.3, 95% CI=1.2-4.1. For acoustic neurinoma OR=4.4, 95% CI=2.1-9.2 was calculated among analogue cellular telephone users. When duration of use was analysed as a continuous variable in the total material, the risk increased per year for analogue phones with OR=1.04, 95% CI=1.01-1.08. For astrocytoma and ipsilateral use the trend was for analogue phones OR=1.10, 95% CI=1.02-1.19, digital phones OR=1.11, 95% CI=1.01-1.22, and cordless phones OR=1.09, 95% CI=1.01-1.19. There was a tendency of a shorter tumour induction period for ipsilateral exposure to microwaves than for contralateral, which may indicate a tumour promotor effect.

Adult↗
PubMed2004

Telephone use and understanding in patients with cochlear implants.

We conducted a mail survey ofpatients who had received cochlear implants to ascertain their ability to communicate on the telephone. Of 86 patients who responded, 38 (44%) did not use the telephone at all, 36 (42%) were able to use the telephone without assistance (independent users), and 12 (14%) were able to use the telephone with some type of assistance. Factors associated with independent use were male sex, older age at the onset of hearing loss, longer duration of hearing loss, successful use of hearing aids prior to cochlear implantation, implantation with a MED-EL Combi 40+ device, and a shorter duration of implant use. But regardless of circumstances, our findings suggest that many cochlear implant patients can use the telephone during daily activity without the need for assistive devices or relay services.

Adolescent↗
PubMed2006

The effect of telephone appointment-reminder calls on outpatient absenteeism in a pulmonary function laboratory.

BACKGROUND: Absenteeism from outpatient appointments is common. Telephone appointment-reminder calls reduce outpatient-appointment absenteeism in many clinic settings. OBJECTIVE: To determine if telephone appointment-reminder calls reduce outpatient absenteeism at a hospital-based pulmonary function laboratory. METHODS: We conducted a retrospective review of our pulmonary function laboratory's outpatient appointment records from April to November 2004. Data were collected from consecutive outpatient appointments, including patient age, sex, whether a telephone appointment-reminder call was successfully made, and whether the patient showed up for the scheduled test. We performed 3 analyses. Differences in absenteeism between the groups was the primary outcome measure. First, appointments were separated into 2 groups: (1) appointments for which a reminder call was attempted ("called" group) and (2) appointments for which a reminder call was not attempted ("not-called" group). The appointments were then separated into 2 further groups: (1) the reminder call was successfully achieved ("contacted" group) and (2) the patient either was not called or was called but could not be reached ("not-contacted" group). Finally, the contacted group was separated into 2 further groups: (1) reminder calls that resulted in direct conversation with an appropriate person at the patient's listed telephone number, and (2) reminder message left on an answering machine. RESULTS: Data were collected from 515 consecutive outpatient appointments; 45 (8.7%) of these patients did not show up for testing. The absentee rate was 4.7% (n = 10) in the called group and 11.6% (n = 35) in the not-called group (p = 0.0066). In the called group, 6.5% (n = 14) could not be reached. The absentee rate was 4% (n = 8) in the contacted group and 11.7% (n = 37) in the not-contacted group (p = 0.0021). We found no difference in absenteeism between patients who received reminders via direct conversation (4.2%) and those who had a reminder message left on an answering machine (3.7%) (p > 0.05). CONCLUSIONS: A policy of reminding outpatients of their appointments via telephone reduces absenteeism at a hospital-based pulmonary function laboratory. We found no difference in absenteeism between communicating the reminder via direct conversation versus via leaving a message on an answering machine.

Appointments and Schedules↗
PubMed2005

Telephone and hot lines: a tool delivering clinical care.

Telephone lines are now a widespread way of communication between patients and physicians. Nevertheless opinions about their effectiveness and efficacy are rather inconsistent. Aim of this study is to review medical literature in order to assess how and when telephone lines have been described as a good or a bad way to help health care, looking for different experiences and opinions, reviews and guidelines about the use of telephone as a tool for delivering health care. We compared what we have found, particularly about Diabetes, with our previous experience. Medline from Pub Med from National Library of Medicine has been consulted using "telephone", "hot line" or "hotline" as key words. Among the 20 thousands references found in the literature, 2051 of them we considered relevant. The most frequently recurrent topics concern pediatrics (19.2%), while diabetes is not very frequent (0.6%). Analyzing more in details, we noticed that the application fields ofhotlines are emergency management, secretary tasks, preventive health care, acute episodes and chronic conditions. Different models of telephone help lines and guidelines in training and running help lines have been found as well. Examining diabetes help lines, we noticed that they are mainly used in case of intercurrent illness, doubts about insulin dose, hypoglycemia. Parents of the youngest patients and with the shortest duration of diabetes are the most frequent users, regardless of HbA1c. Most calls came during holy-days and weekend, especially early in the morning or during the night.

Adolescent↗
PubMed1990

Telephone advice for out of hours calls in general practice.

Telephone advice in out of hours general practice consultations has been infrequently described in the United Kingdom. Data from 13 general practices (77 doctors) in north London were collected over four-week periods. Of the 970 calls recorded, 86% were managed directly by the practice, and 14% by a deputizing service. The percentage of calls managed by telephone advice varied from 5% to 57% (mean 37%). Use of deputies increased at night, but general practitioners remaining on call maintained their telephone advice rates. In all but one practice trainees also gave telephone advice, but the overall proportion of calls managed by trainees (33%) was lower than that of principals (48%). Children and adults under 60 years, more frequently received telephone advice than elderly patients, as did patients noted by the general practitioners as habitual callers compared with other patients.

Family Practice↗
PubMed1990

Effects of telephone call interventions on patients' well-being in a radiation therapy department.

This study examined the effects of telephone call interventions by a collaborative team on patients' well-being. Fifty-five subjects undergoing radiation therapy for cure and who were able to communicate by telephone comprised the sample. Subjects were randomly assigned to a control group, who received the usual care or to an experimental group, who received a weekly telephone call intervention in addition to the usual care. Speilberger's State Trait Inventory, the Side Effects Profile, and the Coping Strategies Profile were used along with a telephone survey to collect data. Analysis of the data showed no significant differences between groups in anxiety, severity of side effects, helpfulness of self-care strategies, and coping strategies. However, the survey indicated that the telephone calls were clinically significant and provided a mechanism for demonstrating that the health care professionals cared about their patients and provided an opportunity for patients to talk about their concerns. The investigators believe that collaboration, caring, and communication are the essence of exemplary health care.

Adaptation, Psychological↗
PubMedDate not supplied

The nature and content of telephone prescribing habits in a community practice.

Prescribing medicine over the telephone was studied during a two-month period in a two-physician fee-for-service private family practice. Of 1,264 telephone calls, 392 (31.0%) resulted in a medication prescription. Of these calls, 176 (44.9%) were for refills of previously prescribed medicines. The most common drugs for new telephone prescriptions were decongestants/antihistamines/antitussives, antibiotics, and pain medications. Medicines were more likely to be prescribed via telephone for the diagnoses of upper respiratory infections, headache, low-back pain, or bronchitis. A patient was more likely than expected to get a telephone prescription for new problems when a message was left in the office for the physician by a caller other than the patient's son or daughter.

Causality↗
PubMed1989

Delegates approve protocol for third-party telephone review.

The Texas Medical Association Physician-Patient Advocacy Committee has conducted an extensive study of the telephone utilization review activities of private third-party payers and self-insured arrangements. Many of these organizations contract with private firms to conduct pre-certification and concurrent review of hospital admissions. These reviews often are accomplished by telephoning the attending physician's office. The procedures and criteria used by these firms and the qualifications of their review staff vary greatly. Physicians and their office staff are spending an increasing amount of time dealing with telephone utilization review. These review firms are not regulated or controlled by any agency. In response to the concerns expressed by physicians in dealing with telephone utilization review, Texas Medical Association's House of Delegates has approved the "Texas Medical Association Recommended Protocol for Physicians Responding to Private Third Party Telephone Review." The guidelines address concerns about confidentiality, physician documentation, patient advocacy, appeals, and cost and billing.

Confidentiality↗
PubMed1978

Telephone performance of persons with hearing handicap in relation to speech reception threshold.

This investigation shows that there are four relevant methods of telephoning in Denmark for hearing-impaired persons: 1) Standard telephone without extra equipment for persons with a Speech Reception Threshold (SRT) up to about 40 dB in the better ear. 2) Standard telephone with receiving amplifier for persons with a SRT up to about 60 dB in the better ear. 3) Standard telephone plus individual hearing aid primarily in "T" position. Can be used by hearing-impaired persons with a SRT up to 70-75 dB in the better ear. 4) Standard telephone with receiving amplifier plus individual hearing aid primarily in "T" position. This is an effective and cheap solution for hearing losses above 70-75 dB in the better ear.

Aged↗
PubMed1988

The nature and content of physician telephone calls in a private practice.

Telephone encounters received by two physicians in a private rural family practice setting were examined over a 61-day sampling period. A total of 1,264 calls were received during the study period, with 905 (71.6 percent) being received in the office setting. An average of 10.4 calls per physician were received each day, and a mean of 16.2 minutes per physician was spent each day with telephone encounters. Each call was brief, lasting 1.6 minutes (standard deviation 1.5 minutes); administrative and personal calls each lasted significantly longer than other call categories (F = 20.8, P = .0001). More chronic disease diagnoses tended to be handled during office when compared with nonoffice telephone encounters. The majority of calls (932, or 83.1 percent) did not require a face-to-face visit as judged by the physician. Of the office calls, 58.2 percent were handled by the physicians through a message system rather than a direct physician telephone call. It is estimated that uncharged care over the telephone saved patients in this practice up to $150,000 per year.

Female↗
PubMed1987

A study of telephone advice in managing out-of-hours calls.

Two doctors in a five-partner urban practice recorded details of their out-of-hours telephone calls for a year. No caller was refused a visit, but 474 of the 809 incoming calls (59%) were managed by telephone advice, an unexpectedly high proportion. Although these callers were instructed to telephone again if still worried, only 40 did so during the same duty period, and only 55% of a smaller sample of patients receiving telephone advice only consulted again within a week. No evident detriment to patients' health was observed. Thirty nine (5%) of the 809 incoming calls were managed by an out-of-hours surgery attendance and 296(37%) by a home visit. The urgency of the visits made was categorized retrospectively as high (34% of visits), medium (39%) and low (27%). It is hoped that this descriptive account will foster discussion of the value and implications of telephone advice in managing out-of-hours calls.

Adolescent↗
PubMed1984

Obtaining information on patient satisfaction with hospital care: mail versus telephone.

Many objectives of the study examined here were to develop a questionnaire useful in eliciting the perceptions of patients regarding their hospital care, to compare the methodologic and substantive differences between a mail survey and a telephone survey of patients done approximately a week post discharge, and to develop methods allowing the questionnaire to be administered by an organization other than the hospital. Two independent surveys were conducted at the same hospital--a telephone survey with a telephone follow-up, and a mail survey with a telephone follow-up. The study demonstrated that an organization external to the hospital can economically conduct a patient satisfaction survey of a representative patient sample while ensuring confidentiality and producing potentially useful results. The mail survey was preferred over the telephone survey due to lower cost, lower chance of biased responses, and complete assurance of confidentiality. The aspects of hospital care most influencing patient satisfaction related to nursing services.

Confidentiality↗