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At least 541 records · Page 30Linked to original sources
PubMed2006

Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial.

OBJECTIVE: To investigate the effects of compliance and periodic telephone counselling by a pharmacist on mortality in patients receiving polypharmacy. DESIGN: Two year randomised controlled trial. SETTING: Hospital medical clinic. PARTICIPANTS: 502 of 1011 patients receiving five or more drugs for chronic disease found to be non-compliant at the screening visit were invited for randomisation to either the telephone counselling group (n = 219) or control group (n = 223) at enrollment 12-16 weeks later. MAIN OUTCOME MEASURES: Primary outcome was all cause mortality in randomised patients. Associations between compliance and mortality in the entire cohort of 1011 patients were also examined. Patients were defined as compliant with a drug if they took 80-120% of the prescribed daily dose. To calculate a compliance score for the whole treatment regimen, the number of drugs that the patient was fully compliant with was divided by the total number of prescribed drugs and expressed as a percentage. Only patients who complied with all recommended drugs were considered compliant (100% score). RESULTS: 60 of the 502 eligible patients defaulted and only 442 patients were randomised. After two years, 31 (52%) of the defaulters had died, 38 (17%) of the control group had died, and 25 (11%) of the intervention group had died. After adjustment for confounders, telephone counselling was associated with a 41% reduction in the risk of death (relative risk 0.59, 95% confidence interval 0.35 to 0.97; P = 0.039). The number needed to treat to prevent one death at two years was 16. Other predictors included old age, living alone, rate of admission to hospital, compliance score, number of drugs for chronic disease, and non-treatment with lipid lowering drugs at screening visit. In the cohort of 1011 patients, the adjusted relative risk for death was 1.61 (1.05 to 2.48; P = 0.029) and 2.87 (1.80 to 2.57; P < 0.001) in patients with compliance scores of 34-66% and 0-33%, respectively, compared with those who had a compliance score of 67% or more. CONCLUSION: In patients receiving polypharmacy, poor compliance was associated with increased mortality. Periodic telephone counselling by a pharmacist improved compliance and reduced mortality. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register: SRCTN48076318.

Adult↗
PubMed1999

Provision of telephone advice from accident and emergency departments: a national survey.

This study sought to gain a national picture of the provision of telephone advice using a postal survey of senior nurses from accident and emergency (A&E) and minor injury units (MIUs). In all, 268/313 (85%) of hospitals/units responded. The average number of calls reported as received per day was 15.5 (median 12; quartiles 6, 20) for weekdays and 21.0 (median 17; quartiles 10, 29) for weekends. Most (89%) viewed the provision of telephone advice as an important component of their work, but few units offered staff training for this role or had implemented protocols or guidelines. Only 5.4% units included the number of calls received in their department in their workload figures, but 91.9% felt that they should be. Extrapolation of the data from this study to all 313 A&E and MIUs in the UK suggests that just under two million calls for telephone advice are currently made to units each year. Recognition and formalization of this aspect of work is likely to be of increasing importance given the constraints on services and the need to manage demand effectively. Future integration of A&E telephone advice calls with NHS Direct should be considered as a means of managing demand and avoiding duplication of service provision.

Counseling↗
PubMed2002

Telephone reminders are a cost effective way to improve responses in postal health surveys.

STUDY OBJECTIVE: To assess the effectiveness of a telephone reminder in increasing responses to postal surveys and to calculate the differential costs per completed questionnaire. DESIGN: Randomised controlled trial. SETTING: Australian university and rehabilitation medicine practice. PARTICIPANTS: The trial was conducted in 1999 among the 143 non-respondents to a questionnaire about work related neck and upper body disorders. The questionnaire was sent to two Australian female samples: 200 office workers (Sample A) and 92 former rehabilitation medicine patients (Sample B). A reminder letter, another copy of the questionnaire and a final letter were sent at two week intervals. Half of the non-respondents within each sample were randomly selected to receive a telephone reminder just after the second mailout of the questionnaire. All direct costs were calculated. MAIN RESULTS: Responses were significantly higher among those who received the telephone reminder intervention (relative risk 2.54, 95% confidence intervals 1.43 to 4.52). Analysed by intention to phone, 47% of non-respondents in Sample A and 38% in Sample B returned a complete questionnaire after the intervention, compared with 21% and 10%, respectively, in the control groups. For the 112 women (combined samples) who returned completed questionnaires before randomisation, the average cost per respondent was AUD14. There was a higher total cost for the intervention groups (AUD851 versus AUD386 for controls), but the significantly higher number of additional completed responses (31 versus 12) resulted in a 15% lower marginal cost per completed questionnaire in those groups. CONCLUSION: Telephone reminders are cost effective in improving responses to postal surveys.

Australian Capital Territory↗
PubMed2006

Patient confidentiality and telephone consultations: time for a password.

UNLABELLED: Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the PROBLEM: a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of access control should improve security while allowing the continuing evolution of telephone consultations.

Computer Security↗
PubMed2000

Using radon risk to motivate smoking reduction: evaluation of written materials and brief telephone counselling.

OBJECTIVE: Radon and cigarette smoking have synergistic effects on lung cancer, even when radon concentrations are relatively low. Working through an electric utility company, we sought to reach smoking households with low radon concentrations and motivate smoking cessation or prohibiting smoking in the home. DESIGN: Eligible homes (n = 714) were randomised to receive: (1) the Environmental Protection Agency's (EPA's) "A citizen's guide to radon"; (2) a specially developed pamphlet; or (3) that pamphlet plus brief telephone counselling. PROCEDURE: Utility company "bill stuffers" offered free radon test kits to smoking households. All households received radon test results with an explanatory cover letter. Both the specially developed pamphlet and the telephone counselling emphasised that smoking cessation or prohibiting smoking in the home were the optimal risk reduction strategies. Households were followed up at 3 and 12 months after receiving materials. RESULTS: The specially developed pamphlet and the EPA guide yielded similar outcomes. There was a non-significant trend for telephone counselling to produce greater sustained quitting than the specially developed pamphlet, and phone counselling led to significantly more new household smoking bans. CONCLUSIONS: Working through a public utility company is an efficient way to reach smoking households, and brief telephone counselling is a promising method for promoting household smoking bans and cessation in homes alerted to the risk posed by the combination of radon and smoking.

Counseling↗
PubMed1986

The evolution and effectiveness of telephone counseling services.

Despite dramatic expansion of telephone counseling services during the last three decades and widespread belief in their preventive and therapeutic value, empirical evidence of their effectiveness is limited, partly because of methodological and practical difficulties associated with research in the field. A review of existing studies indicates that telephone counselors may perform valuable listening, information giving, and referral roles. Evidence is lacking, however, on the ability of telephone counseling to produce behavior change in callers or to reduce suicide rates. Recent studies indicate that contract telephone counseling may have considerable therapeutic potential for monitoring and supporting clients with ongoing problems or chronic disabilities.

Counseling↗
PubMed1996

An analysis of telephone calls to an inner-city accident and emergency department.

The general public in the UK often telephone accident and emergency (A&E) departments for medical advice. Such calls are usually dealt with by nursing staff in an informal manner (often with no written record of the call being made). The specific questions addressed in this study are who was calling for advice, when did they call, what were their presenting complaints, and what was the outcome of the call? In addition, the study provided an opportunity to test the implementation of a new system of record-keeping for telephone consultation. A telephone consultation record (TCR) was developed and used to record details of each call made to the A&E department for medical/health advice. An analysis of 597 consecutive documented calls is presented in this paper. The majority of calls were dealt with by 'E' grade nursing staff (42.7%); only four calls (0.7%) were recorded by medical staff. Two hundred and six (43.5%) calls related to patients aged up to 15 years. In 57% of the cases the call was made by a third party. In all, 149 different presenting complaints were recorded on the TCRs. The three most common presenting complaints were dental problems (7.4%), fever (4.3%), and concerns about drug reactions (23%). Seventy-three per cent of callers were advised that a visit to the A&E department was not immediately necessary. The study identifies several important issues for development of a more formal and effective system of telephone advice. The majority of calls made to the A&E department appeared to be of a primary care nature but the extent to which nurses are trained to assess and advise on these problems needs to be questioned. A reluctance to document the calls to A&E was identified, one reason being a concern about accountability. Training and support are clearly required.

Adolescent↗
PubMedDate not supplied

The role of the certified diabetes educator in telephone counseling.

PURPOSE: This paper describes a telephone-based, outcomes-focused approach to diabetes education provided by certified diabetes educators (CDEs). METHODS: Random chart audits were conducted to evaluate the scope of practice and effectiveness of telephone-based interventions provided by CDEs to people with diabetes. Four case studies and a sample prevention case are used to illustrate the role of telephone-based CDEs in providing diabetes education. RESULTS: Counseling provided by CDEs helped to identify potential barriers and strategies for making lifestyle behavioral changes. CONCLUSIONS: Telephone-based counseling is a brief, effective, ongoing intervention that gives patients with diabetes immediate access to CDEs who provide education to support lifestyle behavioral changes.

Allied Health Personnel↗
PubMed1997

Observations based upon multiple telephone contacts with new breastfeeding mothers.

Common themes and phenomena were identified by a lactation consultant providing an average number of nine follow-up phone contacts per mother during an average of 12 1/2 weeks postpartum. Over 600 mother-infant couples received lactation support services in the past 6 years. Eighty-six percent of the mothers receiving this telephone support breastfed for at least 1 month, 46% breastfed at least 3 months, and 23% breastfed for at least 5 months. Co-sleeping was encouraged in the first week postpartum, as was nursing one breast per feed. Normal breastfeeding was identified when the mothers nursed comfortably (save for first-minute latch-on pain), when they reported having fun with their babies, when their babies woke spontaneously to feed and to look around, when their babies urinated sufficiently and either had bowel movements or passed flatus, and when their babies were observed to smile. Anticipatory guidance about areolar engorgement, growth sports, and continuing to nurse despite maternal illness reduced bottle use in the first few weeks. The majority of women had no problems establishing breastfeeding with daily telephone contact for the first 5-7 days postpartum, one to three calls per week for the next few weeks, and gradually diminishing calls thereafter. Telephone calls were initiated by the LC, as only 12-16% of mothers called for help, even though they all received the LC's home telephone number.

Breast Feeding↗
PubMed1997

Development and validation of a Structured Telephone Interview for Dementia Assessment (STIDA): the NIMH Genetics Initiative.

As part of the NIMH Genetics Initiative Alzheimer's Disease (AD) Study Group, a brief structured telephone interview to distinguish individuals with normal cognitive functioning from those with changes in cognition and daily functioning suggestive of early AD was developed. The Structured Telephone Interview for Dementia Assessment (STIDA), yields a dementia score between 0 and 81 (higher scores indicating greater impairment). Subscales corresponding to the subscales of the Clinical Dementia Rating Scale (CDR) can be derived. The STIDA performed well as a screening instrument for mildly demented individuals. When a score of 10 or more (based on informant interview and subject testing) was used to identify mildly impaired individuals, the STIDA had a sensitivity of .93 and a specificity of .92 for a clinician-derived CDR of 0.5 or more. The STIDA was also capable of accurately assessing the level of dementia. STIDA-derived CDR ratings agreed with clinician-derived CDR scores in 23 of 28 cases, corresponding to an unweighted kappa of.71 and a weighted kappa of.81. A much-abbreviated short STIDA that could be administered directly to the subject was able to detect possible impairment with a sensitivity of .93 and a specificity of.77. These results suggest that the short STIDA provides a sensitive and fairly specific telephone screen for dementia, and that the full STIDA, consisting of an interview with a knowledgeable informant and subject testing, approximates the success of a face-to-face clinical interview, and provides reliable and valid screening and staging of dementia over the telephone.

Aged↗
PubMed1999

Comparability of telephone and In-person structured clinical interview for DSM-III-R (SCID) diagnoses.

The SCID was administered twice, once by telephone and once in person (1 week later) to 41 college age men. For major depression (lifetime k =.64, current k =.66), results indicated good agreement. The lifetime occurrence estimate based on the telephone SCID diagnosis was lower than the in-person SCID estimate. Kappas for specific diagnoses were calculable for simple phobia (lifetime k =. 47, current k = .03) and social phobia (lifetime k =.29). Base rates were less than 10% for all individual diagnoses except lifetime major depression; therefore, the kappas may be unstable. For all diagnoses where there were any positive cases, percentages of negative agreement and specificity were high, whereas percentages of positive agreement and sensitivity were lower. Overall agreement was fair for specific lifetime diagnoses but poor for current diagnoses. These results suggest caution in assuming comparability of in-person and telephone SCID diagnoses. Circumstances under which a telephone SCID may be useful and ways to improve reliability are discussed.

Adjustment Disorders↗
PubMed2005

The effect of telephone social support and education on adaptation to breast cancer during the year following diagnosis.

PURPOSE/OBJECTIVES: To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer. DESIGN: Multisite, two-group experimental study with repeated measures. SETTING: Arkansas and New Jersey. SAMPLE: The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were randomly assigned to an experimental or control group. The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support resulted in more positive, statistically significant adaptation to the disease. METHODS: The experimental group received 13 months of telephone social support and education. Both groups received educational materials via a mailed resource kit. The Profile of Mood States; Visual Analogue Scale-Worry; Relationship Change Scale; University of California, Los Angeles, Loneliness Scale-Version 3; and the modified Symptom Distress Scale provided data regarding the variables of interest. Data analysis included descriptive statistics, t tests, and multivariate analysis of variance with repeated measures. MAIN RESEARCH VARIABLES: Mood, worry, relationships with significant others, loneliness, and symptoms. FINDINGS: Data analysis showed no significant differences between groups, and both improved on some of the outcomes. Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey samples, thereby supporting the need to consider regional differences when developing interventions. CONCLUSIONS: The mailed educational resource kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed resource kit. IMPLICATIONS FOR NURSING: Mailed educational resource kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer, but their effect may differ according to region.

Adaptation, Psychological↗
PubMed2006

Telephone interventions by nursing students: improving outcomes for heart failure patients in the community.

Community care for heart failure patients is difficult due to multiple comorbidities, polypharmacy, and advanced age of patients. Studies show that hospital admissions and emergency room visits decrease with increased nursing interventions in home and community settings. The purpose of this study(1) was to assess the effectiveness of regular telephone interventions by nursing students on outcomes of heart failure patients in the home. Senior students were paired with community nursing staff and assigned 2 heart failure patients to follow up by telephone calls for 12 to 14 weeks. Patients who received telephone interventions had fewer hospital readmissions (13%) than the comparison group (35%). Patients in the telephone intervention group also had fewer overt heart failure symptoms as measured by the Minnesota Living With Heart Failure Questionnaire.

Aftercare↗
PubMed2004

Is telephone follow-up as good as traditional clinic follow-up in achieving the proposed national outcome standards for chlamydia management?

A retrospective review of 400 cases of genital chlamydia managed with a traditional clinic follow-up was compared to 400 cases with a telephone follow-up appointment. We satisfactorily treated more patients with the telephone follow-up appointment than with a traditional clinic follow-up (204 [51%] vs 121 [30%]; P <0.0001). We also satisfactorily treated more partners with the telephone follow-up system than a traditional clinic appointment system (0.57 vs 0.45 contacts per case; P =0.0006). The introduction of the telephone follow-up appointment system in the clinic increased the number of patients and contacts of patients successfully managed for genital chlamydial infection. Our findings should lead to increased research and adoption of different methods of follow-up and help develop proper outcome standards.

Adolescent↗
PubMed2002

Validation of a telephone cognitive assessment test battery for use in chronic fatigue syndrome.

We compared a computerized version of the Cognitive Drug Research (CDR) cognitive assessment test battery and a completely automated telephone version of the same battery. These assessed aspects of attention, working memory and long-term memory. Both methods were used to assess the cognitive performance of a cohort of 30 people with confirmed chronic fatigue syndrome (CFS) and a group of 30 healthy controls matched for age and education. The CFS group had significantly slower reaction times on all four cognitive measures on both the computerized and telephone tests. The mood data followed similar patterns inthe computer and telephone assessments. The results from both forms of the test battery confirmed the pattern and severity of cognitive impairment in CFS. Furthermore, the two methods of testing were similarly sensitive in detecting cognitive deficits. The incapacitating nature of CFS may cause problems for researchers if the restrictions to mobility affect the representativeness of the study group. The findings of the present study support the use of a fully automated telephone cognitive testing system for detecting deficits in CFS.

Attention↗
PubMed2004

A system for telephone and secure email consultations, with automatic billing.

Doctors have traditionally provided medical advice during face-to-face consultations. A new remote consultation service has been developed based on an interactive voice response system and Internet-based technologies. If the doctor is unavailable, a return call can be requested at a mutually convenient time. The patient's credit card is billed automatically. All that is required of the doctor and patient is access to any telephone. A dial-in dictation and transcription facility allows documentation. The service was launched in late 2003. After six months, there were approximately 55 doctors registered in five Australian states and approximately 500 patients registered. Two hundred and fifty consultations were selected randomly for analysis. Of these, 84% were conducted by telephone and 16% by email. The mean fees charged were AUS$17.11 for telephone and AUS$12.93 for email consultations. The mean duration of telephone consultations was 4.3 min. Call duration ranged from a few seconds to 20.5 min.

Australia↗
PubMed1998

Headaches from cellular telephones: are they real and what are the implications?

There have been numerous recent reports of headaches occurring in association with the use of hand-held cellular telephones. Are these reported headaches real? Are they due to emissions from telephones? There is reason to believe that the answer is "yes" to both questions. There are several lines of evidence to support this conclusion. First, headaches as a consequence of exposure to low intensity microwaves were reported in the literature 30 years ago. These were observed during the course of microwave hearing research before there were cellular telephones. Second, the blood-brain barrier appears to be involved in headaches, and low intensity microwave energy exposure affects the barrier. Third, the dopamine-opiate systems of the brain appear to be involved in headaches, and low intensity electromagnetic energy exposure affects those systems. In all three lines of research, the microwave energy used was approximately the same--in frequencies, modulations, and incident energies--as those emitted by present day cellular telephones. Could the current reports of headaches be the canary in the coal mine, warning of biologically significant effects?

Blood-Brain Barrier↗
PubMed2004

Improving patient safety by repeating (read-back) telephone reports of critical information.

Reducing the rate of avoidable errors is crucial to patient safety. Telephone calls with misunderstood critical results constitute one area in which opportunities for improvement exist. The aviation industry has dealt with this issue by requiring pilots to repeat instructions received from the air traffic controller. At 3 health care organizations, we tested a program to decrease telephone reporting errors by requiring the recipients of critical results to repeat the message. Of 822 outgoing telephone calls from the laboratory, 29 errors were detected (error rate 3.5%). Calls to physicians had the highest rate of errors (6/95 [5%]). The time required to ask for the information and for the message to be repeated averaged 12.8 seconds per call, which corrected 29 errors. A simple system of repeating telephoned laboratory results has the potential to reduce the risk of medical errors and improve patient safety.

Humans↗