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PubMedDate not supplied

Telephone follow-up program evaluation: application of Orem's self-care model.

The traditional model of nursing, in which patients are discharged with a follow-up medical appointment, is no longer sufficient in the current healthcare environment. Primary nurses working in a 58-bed rehabilitation unit located in a 1,700-bed tertiary care medical center implemented a follow-up telephone call program to support the patient's transition from acute rehabilitation nursing care to community living. Patients discharged to home within a five-state area were called 2 weeks and 6 weeks after discharge. Notes on the telephone conversations were entered on a data collection form and later analyzed using Orem's self-care deficit theory (Orem, 1991). A total of 144 follow-up calls were made. During the first call (n = 105), 157 problems (1.5 per call) were noted, whereas 79 (2.0 per call) were identified during the second call (n = 39). Medication, safety, and bladder problems were most often cited as concerns by patients and caregivers after discharge. The most frequently used helping interventions during both the first and the second telephone calls were guiding and supporting.

Adolescent↗

PubMed2007

Long-term telephone therapy outcomes for breast cancer patients.

We present the results of a breast cancer clinical trial that tested two therapy interventions delivered by telephone. Women (N = 218) with Stages I, II, or III breast cancer were randomly assigned to breast cancer health education or emotional expression interventions, or to a standard care control condition. Outcome and process measures were obtained at baseline, 6-month and 13-month follow-ups. Oncology certified nurses conducted the therapies in six, 30-minute individual phone sessions. Women in the health education condition reported significantly better knowledge and less perceived stress compared to women in the emotional expression and control conditions. No treatment effects, however, were obtained for quality of life or mood, and all women generally improved on these measures over time. Secondary analyses showed that younger women and women with a more advanced stage of breast cancer reported significantly greater avoidant coping. The data show that telephone therapy is a viable delivery modality and that distress improves with time for most women. Overall, this study showed that neither of the two telephone interventions tested had a meaningful effect on quality of life or mood.

Adaptation, Psychological↗

PubMedDate not supplied

Improved screening for breast cancer associated with a telephone-based risk assessment.

BACKGROUND: Our objective was to develop and field-test a telephone-based breast cancer risk assessment and to assess its efficacy in improving screening behavior. The study was performed at a financial institution and a manufacturing corporation with main offices in Boston, Massachusetts, and branch offices in various regions of the United States. METHODS: A longitudinal study consisting of an initial health risk assessment administered by telephone, with a subsequent follow-up study initiated 8 months later, was performed. Study design was influenced by some of the suggestions made by the benefits departments of the corporate sponsors. A voice-response, telephone system collected risk information from callers and gave real-time risk assessment. These callers could receive a risk assessment over the phone and remain completely anonymous or furnish name and address to receive a more detailed written report. Main outcome measures included the response rate and demographics of the respondents, risk profiles of the callers, and breast cancer screening statuses. RESULTS: There were 343 participants of whom 189 relinquished anonymity to receive more detailed information by mail and were available for a follow-up study. Sixty-three women (18%) reported a family history of breast cancer, with 34 women (10%) responding that one first-degree blood relative had been diagnosed before the age of 50. A strong positive correlation between the level of familial risk and the decision to remain anonymous existed (P < 0.0001). There was an increase in compliance with breast self-examination from 34% (40/119) at time of use of the system to 62% (74/119) at follow-up, P < 0.0001. Clinical breast exams showed similar improvements, from 82 (98/119) to 92% (110/119), P < 0.0137. Paired and unpaired data of women 40 years of age and older indicate an improvement in mammography compliance from time of system use to follow-up, 76 (22/29) to 93% (27/29), P < 0.0572, and 79 (33/42) to 93% (27/29), P < 0.0129, respectively. CONCLUSIONS: A population of women with a risk profile higher than that of the U.S. population called the survey. System use is associated with an improvement in breast cancer screening habits. Self-reported, increased genetic risk for breast cancer was strongly correlated with a decision to remain anonymous.

Adolescent↗

PubMed2002

Effectiveness of telephone counseling for mammography: results from five randomized trials.

BACKGROUND: Women over age 50 continue to be underscreened for breast cancer. The purpose of this report is to compare the effectiveness of a barrier-specific telephone counseling intervention across the five study sites of the Breast Cancer Screening Consortium (BCSC). METHODS: Each of the BCSC projects was a randomized study of the effectiveness of telephone counseling (TC) in comparison to a control condition. Eligible underusers were identified and surveyed by telephone before and after the implementation of the interventions. Data from a total of 3,461 underusers were analyzed. We tested whether significantly more women randomized to TC than to control were regular mammography users at the follow-up survey. Data were analyzed separately by site. RESULTS: Overall, TC was not significantly more effective than control in encouraging regular mammography. The pooled consortium-wide odds ratio was 1.08 (95% confidence interval: 0.91 to 1.27). CONCLUSIONS: TC has the potential to support maintenance of mammogram use. Modifications are needed to maximize this potential and additional methods should be used in conjunction with TC to reach women who are underusers of mammography.

Aged↗

PubMed1977

An evaluation of the effectiveness of a telephone counseling center.

Three-thousand questionnaires were distributed to students on campus to identify a sample of actual telephone counseling center users and their ratings of the effectiveness of the help received and of the counselor. Ratings of help received and impact of counseling on life as it is today were considered for sex of caller and counselor across type of problem. A sample of 66 actual callers was identified who had used the service for personal problems at least once. Of male callers, 67% reported that telephone counseling helped at least somewhat, while 80% of female callers reported favorable results of telephone counseling. Female callers who talked with male counselors reported a significantly greater impact on their life than did the callers in any other caller/counselor sex interaction. Only one average rating of counseling effectiveness by problem type fell below the neutral rating. Results are presented as evidence for the effectiveness of paraprofessional counselors.

Allied Health Personnel↗

PubMed1977

The use of volunteers in a community mental health center emergency and reception service: a comparative study of professional and lay telephone counseling.

A model of volunteer participation in a community mental health center emergency and reception service is presented and tested by comparing the telephone counseling effectiveness of volunteers and community mental health professionals. Experienced and inexperienced volunteers, professionals, and control subjects responded to simulated telephone crisis calls that were tape-recorded and replayed for ratings along seven scales which assessed various dimensions of counseling effectiveness. The results suggested that carefully selected and trained volunteers can function as effectively as professional staff in providing supportive and emergency telephone services for distressed callers and community mental health center clients.

Community Mental Health Services↗

PubMed1979

[Suicide prevention: role and efficacy of telephone assistance services].

This paper deals with the effectiveness of emergency telephonic help services in suicide prevention; it gives an historical account, describes the activity of Geneva's "Main Tendue" and proposes some practical principles on emergency telephonic help. 41 calls of 35 callers of Geneva's telephonic help service are briefly analyzed. A review of the literature available on this subject leaves a pessimistic impression about effectiveness of such services.

Adult↗

PubMed2007

A telephone-based intervention for depression in HIV patients: negative results from a randomized clinical trial.

To determine if a telephone support behavioral intervention improves depressive symptoms among HIV positive outpatients, we enrolled 177 persons with Beck Depression Inventory (BDI) scores scores of >/=10. Participants were randomized to receive up to 12 scheduled psycho-educational calls over 6 months or to an assessment-only control condition. Co-enrolled informal caregivers of HIV patients received the same telephone intervention in parallel. Among the 160 (90.4%) participants who were re-interviewed at 6 months, 56% were male, and 41% were Caucasian, with a mean baseline BDI score of 22.7. Overall, participants' mean BDI scores improved 5.3 points from baseline, but intervention group differences on depression outcomes including 50% or greater reduction in BDI scores and depression remission were not statistically significant. In the full cohort, men were significantly more likely to improve than women. We conclude that a psycho-educational telephone support intervention did not reduce depressive symptoms for HIV patients more than an assessment-only control condition.

Adult↗

PubMed2006

Telephone monitoring and support for veterans with chronic posttraumatic stress disorder: a pilot study.

Dropout from outpatient mental health treatment may contribute to high rates of relapse and rehospitalization among veterans with chronic posttraumatic stress disorder (PTSD). In a quasi-experimental cohort study, 87 male and 17 female veterans discharging from residential PTSD treatment received either standard referral to outpatient care (N = 77) or standard referrals supplemented by biweekly telephone calls (N = 27). Telephone monitoring and support was feasible and acceptable to 85% of clients. Compared to prior patient cohorts, clients receiving telephone support were twice as likely (88% vs. 43%) to complete an outpatient visit within 1 month of discharge and reported higher satisfaction with care.

Adult↗

PubMed1990

The use of covert sensitization and social skills training in the treatment of an obscene telephone caller.

This case study examines the use of covert sensitization and social skills training to treat an obscene telephone caller on a behaviorally-oriented inpatient psychiatric unit. Rapid decreases in penile tumescence associated with obscene telephone calling were obtained after covert sensitization treatment and were maintained at one year follow-up. Social skills training led to a decrease in social anxiety and increase in social behavior. Results support the combined clinical effectiveness of covert sensitization and social skills training for the treatment of obscene telephone calling.

Adult↗

PubMed1995

Efficacy of telephone-administered behavioral therapy for panic disorder with agoraphobia.

The purpose of this study was to determine the efficacy of a structured exposure-based behavior therapy program delivered by telephone to agoraphobic individuals who were isolated from specialized treatment centres. Forty-two individuals with a DSM-III-R diagnosis of panic disorder with agoraphobia who were living in rural areas of Ontario were assigned to either an eight-session telephone behavior therapy program or wait-list control condition. There were significant treatment x time interaction effects on several outcome variables. Patients originally in the wait-list group then received the same type of therapy and they also significantly improved. All treatment gains were maintained at three-month and six-month follow-up. Telephone behavior therapy appears to be a cost-effective and efficacious treatment for agoraphobics living in remote regions where specialized anxiety disorder services are not readily available.

Adult↗

PubMed1988

Agreement between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule.

To increase the feasibility of identifying persons with depressive disorders in a large-scale health policy study, we tested the concordance between face-to-face and telephone-administered versions of the depression section of the NIMH Diagnostic Interview Schedule (DIS). This section was administered over the telephone to 230 English-speaking participants of the Los Angeles site of the NIMH Epidemiologic Catchment Area Program (ECA) after their completion of a face-to-face interview (Wave II) with the full DIS. Time lag between interviews was 3 months, on the average. Persons with depressive symptoms were oversampled. Using the face-to-face version as the criterion measure, the sensitivity, specificity, and positive predictive value of the telephone version for identifying the presence or absence of any lifetime unipolar depressive disorder were 71, 89, and 63 percent, respectively; the kappa statistic was 0.57, and agreement was unbiased. The comparable figures for concordance between two face-to-face interviews administered one year apart to the same subjects were 54, 89, and 60 percent and 0.45 (kappa), respectively. Thus, disagreement was due primarily to test-retest unreliability of the DIS rather than the method of administration.

Adolescent↗

PubMed1994

The telephone interview as a data collection method.

The interview is one of the most frequently used methods of collecting qualitative data. This paper offers a description of how the telephone interview may be used to collect data in both qualitative and quantitative studies. It offers a description of how to plan and use the telephone as a means of collecting data and justifies the use of this method. The paper also describes and illustrates how textual data that arises from the use of telephone interviews may be analysed by computer. Two approaches to analysis are outlined: (1) simple drawing together of responses to questions and (2) the searching for categories within the data and the organisation of text within those categories. The paper identifies limitations of the approach to data collection and points to further reading on the topic.

Humans↗

PubMed1996

Fetal heart rate monitoring by telephone during pregnancy--opinion of users and non-users of a new technology.

OBJECTIVE: To compare the opinions of obstetricians who currently use fetal heart rate monitoring (FHRM) by telephone with the opinions of obstetricians in favour of this technique, but who do not use it. STUDY DESIGN: A mail questionnaire was sent to the 612 members of a professional organization of obstetricians. The response rate was 76%. RESULTS: Fourteen percent of the respondents used FHRM by telephone and 43% did not use it, but were in favour of it. Compared with current users, non-users who were in favour of this technique indicated a wider range of clinical indications for monitoring, considered a greater proportion of women to be eligible, and wanted more frequent monitoring. These differences cannot be explained by the characteristics of the obstetricians (age, type of practice or attitude towards FHRM performed in maternity unit). CONCLUSION: Our survey shows a risk of extensive use of FHRM by telephone if this technique becomes easily accessible.

Female↗

PubMed1984

The 911 emergency telephone number: impact on emergency medical systems access in a metropolitan area.

The telephone number 911 is designated for public use in requesting emergency assistance. It is thought to reduce response time by reducing the interval between the decision to call for assistance and the notification of an agency that can dispatch the appropriate services. The experience of the Twin Cities metropolitan area of Minneapolis-St. Paul provides a unique opportunity to examine this assumption. Prior to the introduction of the 911 emergency telephone number on December 1, 1982, the area was serviced by over 100 different seven-digit emergency telephone numbers. Before the introduction of 911, 347 callers who activated the emergency medical services (EMS) system were interviewed, and after 911 was introduced, 305 callers were interviewed. Activation of the EMS system by making one call in less than 1 minute was achieved by 219 of 347 callers (63%) in the pre-911 phase and by 251 of 305 callers (82%) in the post-911 phase (P less than 0.001). Compliance (use of an appropriate emergency number for the first call) was demonstrated by 139 of 347 callers (40%) in the pre-911 phase, and 225 of 305 callers (74%) in the post-911 phase (P less than 0.001). Rapid activation of the EMS system was rarely achieved by calling a hospital or physician first. Overall, 911 was found to be a more efficient means of activating the EMS system.

Consumer Behavior↗

PubMed1993

Validity of cardiovascular disease risk factors assessed by telephone survey: the Behavioral Risk Factor Survey.

The Behavioral Risk Factor Surveillance System (BRFSS) collects telephone interview data on behaviors for the leading causes of premature death and disability. Its validity has never been adequately studied. The authors replicated BRFSS methodology to validate self-reported cardiovascular disease (CVD) risk factors. Nine-hundred and eleven subjects from three upstate New York counties were interviewed between 1/89 and 5/90. Interviewees were offered physical examinations and laboratory testing for CVD risk factors; 282 men and 344 women participated. The authors studied validity by comparing objectively measured to self-reported CVD risk factors. Sensitivities for self-reported hypertension, hypercholesterolemia, obesity, smoking, and diabetes were: 43, 44, 74, 82 and 75%, respectively. Only smoking sensitivity differed by gender: men, 77%; women, 86%. Specificity was > 85% for all risk factors, except hypercholesterolemia in men (75%). Prevalence was underreported for hypertension, hypercholesterolemia, obesity, and smoking by 43, 50, 25 and 17%, respectively. Results suggest telephone survey research includes physiologic measurements for blood pressure, cholesterol, height, weight, and smoking to validate self-reported CVD risk factors. When this is impossible, results such as these can be used, in similar samples, to correct risk factor prevalence rates from telephone surveys for misclassifications.

Adult↗

PubMed1996

A computer-assisted telephone interview technique for assessment of asthma morbidity and drug use in adult asthma.

This study concerns an analysis of the feasibility, validity, and repeatability of telephone interviews for the collection of data concerning health-related quality of life in asthma and patient reports of their use of asthma therapy. A computer-assisted hierarchical interview algorithm was developed that allowed rapid and precise recording of all aspects of asthma medication including drug, dose, and delivery system. This questionnaire was used together with the Symptoms and Impacts components of the St. George's Respiratory Questionnaire (SGRQ) in one face-to-face and then in three computer-assisted telephone interviews (CATIs) that took place 1, 3, and 13 weeks later. One hundred patients with asthma who had received inhaled steroids within the previous year were identified from general practice records. The intraclass correlation between the face-to-face interview and the first CATI for the SGRQ scores and the daily dose of inhaled steroid was approximately 0.8. For daily bronchodilator use, this value was 0.56. The intraclass correlation obtained between two CATIs 3 months apart was a little lower: SGRQ scores, 0.78; inhaled steroid dose, 0.67; bronchodilator use, 0.58. Telephone interviews can provide repeatable and efficient measurements of health and patient-reported drug use in asthma.

Administration, Inhalation↗

PubMed2006

Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care.

BACKGROUND: Improved self-care behaviour is a goal in educational programmes for patients with heart failure, especially in regard to daily self-weighing and salt and fluid restriction. AIMS: The objectives of the present study were to: (1) describe self-care with special regard to daily self-weighing and salt and fluid restriction in patients with heart failure in primary health care, during one year of monthly telephone follow-up after a single session education, (2) to describe gender differences in regard to self-care and (3) to investigate if self-care was associated with health-related quality of life. METHODS: The present analysis is a subgroup analysis of a larger randomised trial. After one intensive educational session, a primary health care nurse evaluated 60 patients (mean age 79 years, 52% males, 60% in New York Heart Association class III-IV) by monthly telephone follow-up during 12 months. RESULTS: The intervention had no effect on quality of life measured by EuroQol 5D and no significant associations were found between quality of life and self-care behaviour. Self-care behaviour measured by The European Self-care Behaviour Scale remained unchanged throughout the study period. No significant gender differences were shown but women had a tendency to improve adherence to daily weight control between 3- and 12 months. CONCLUSION: The self-care behaviour and quality of life in patients with heart failure did not change during one year of monthly telephone follow-up after a single session education and this indicates a need for more extensive interventions to obtain improved self-care behaviour in these patients.

Aftercare↗