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PubMed2002

Safe and sound.

Telephone triage requires careful staff selection, support, and service supervision.

Clinical Competence↗
PubMedDate not supplied

'Linking the orthopaedic patient with community family violence resources'.

An early article on health system response to domestic abuse by Randall in JAMA stated that health providers may be the first and only professionals in a position to recognize violence in their patient's lives. Health providers see many more victims of domestic violence than they realize. In fact, victims of domestic violence will interact with their health providers for both routine and abuse-related care. Early, effective intervention can interrupt the cycle of violence, prevent more serious injuries and symptoms, prevent long-term mental health and psychiatric symptoms, and prevent abuse to children. The most important contribution health providers can make to end abuse and protect the health of its victims is to identify and acknowledge that abuse, because that alone can empower the victim to begin a progression toward safety.

Community Health Services↗
PubMed2001

Prospective study of telephone consultation and communication in pediatric infectious diseases.

BACKGROUND: Subspecialists are often called on to provide informal or "curbside" telephone consultation. There is limited documentation of the time spent on, content, nature and source of such consultations by pediatric infectious disease (PID) specialists. Nursing staff frequently assist physicians by triaging telephone calls. No previous studies have examined this aspect of their role in subspecialty practice. METHODS: We prospectively recorded all telephone calls to a newly established PID program for 1 year. Results were entered into a database and analyzed using the ABSTAT software. RESULTS: A total of 621 calls were received by the PID specialist and 1,260 by the PID nurse from March 1, 1999, through February 29, 2000. The mean number of calls per month was 51.8 +/- 24.8 for the physician and 105 +/- 43.3 for the nurse. The mean time spent per call was 9.6 +/- 5.9 min for the physician and 3.3 +/- 1.4 min for the nurse. A total of 103.5 h were spent directly on telephonic consultation/communication by the physician and 68.7 h by the nurse, respectively. Of the calls to the physician 78.6% came from other physicians, 51.5% being pediatricians in practice and 57% involving case management. Calls to the nurse were primarily from the laboratory (26.3%), with 93% regarding patients seen on the inpatient or outpatient service. CONCLUSIONS: Telephone consultation/communication is an integral and important part of a PID practice.

Communicable Diseases↗
PubMedDate not supplied

Usefulness of human immunodeficiency virus post-test counseling by telephone for low-risk clients of an urban sexually transmitted diseases clinic.

BACKGROUND: Failure of clients to return for post-test counseling for human immunodeficiency virus (HIV) has been noted consistently as a problem with HIV counseling and testing in sexually transmitted disease clinics. GOALS: To assess trends in the rates of HIV post-test counseling in an urban sexually transmitted disease clinic. To determine the usefulness of providing post-test counseling by telephone to clients at low risk for HIV as a means of increasing post-test counseling rates and efficiency of clinic operations. STUDY DESIGN AND METHODS: Human immunodeficiency virus post-test counseling rates were evaluated among clients of a sexually transmitted disease clinic from January 1990 through May 1994. Low-risk clients (n = 1,304) from July 1994 through September 1994 were given the option of obtaining negative HIV test results by telephone. Rates of post-test counseling within 45 days were compared with historical controls from March 1994 through May 1994, during which time a return visit was required. RESULTS: The rate of post-test counseling increased significantly from 1990 to 1992 but remained stable thereafter. After the introduction of post-test counseling by telephone, 704 of 1,304 low-risk clients (54.0%) obtained post-test counseling compared with 476 of 1,187 (40.1%) clients during the control period (odds ratio = 1.75; 95% confidence interval = 1.50-2.06). Post-test counseling rates increased especially among clients younger than 20 years of age (30.6% versus 52.7%) and among those with multiple new sex partners in the last month (31.6% versus 56.1%). CONCLUSIONS: Telephone post-test counseling is an effective method of increasing access for low-risk clients attending sexually transmitted diseases clinics and may be especially useful for those who are otherwise unlikely to obtain post-test counseling.

Adult↗
PubMed1990

American Cancer Society's Breast Cancer Detection Awareness Program: the 1988 middle Tennessee experience.

In an effort to augment public awareness of the benefits of screening mammography and to encourage the use of screening mammograms, the Tennessee Division of the American Cancer Society initiated the Breast Cancer Detection Awareness Program in March 1988. As a result of the initiative, 3,473 women telephoned for information, and 3,123 were found to be eligible for a screening mammogram. Of the 2,248 mammograms actually obtained, 1,764 (78%) were interpreted as normal, whereas 484 (22%) were classified as abnormal. Of the 484 women with abnormal mammograms, 277 (57%) were advised to have follow-up mammograms and 57 (12%) had excisional biopsy. The 55 biopsies reported showed benign changes in 83.6% and malignancy in 16.4%. Thus, nine malignancies were discovered from 2,248 screening mammograms (four malignancies per 1,000 mammograms). No malignancies were found in women between 35 and 39 years old.

Adult↗
PubMed2005

An analysis of spoken language expression during simulated emergency call triage.

OBJECTIVES: Volunteer citizens were recruited to perform simulated emergency calls, and the expressions and content of these telephone calls were analysed to examine risk factors associated with the success or failure of communication. SUBJECTS AND METHODS: Six physicians played the role of patients who had various symptoms, such as cerebral stroke and ischaemic heart disease. Eighty-four volunteer citizens made simulated emergency calls. Physicians at a simulated call centre communicated with each caller regarding the patient's body position, respiratory condition, and cardiovascular status. Details of the telephone communications were analysed to determine if communication was successful. RESULTS: Telephone communications that resulted in the correct understanding of a simulated patient's condition were as follows: 60.2% of sessions (32/50) on whether or not a patient was breathing; 47.8% of sessions (22/46) on whether or not a patient had a pulse (carotid or radial artery); and 86.2% of sessions (56/65) on patient body position. How a simulated dispatcher verbally expressed questions was the most influential factor in the success of communication regarding respiratory condition and body position. Avoiding vague language, giving specific instructions for checking a patient, and finally reminding the caller to perform the explained procedures led to a high rate of successful communications. Various spoken expressions by simulated dispatchers in confirming patient pulse did not have any impact on the success or failure of communications. CONCLUSION: In developing a 'protocol for emergency call triage' to achieve a high rate of successful emergency communications, an analysis of expressions using simulated patients is useful.

Communication↗
PubMedDate not supplied

Giving away free nicotine medications and a cigarette substitute (Better Quit) to promote calls to a quitline.

This article presents results from two population-based promotions for free cessation products used to induce smokers to call the New York State Smokers'. The first promotion was a press announcement urging smokers to call the quitline to get a voucher for a free 2-week supply of nicotine patches or gum (nicotine replacement therapy [NRT]). The second promotion involved comparing response to two newspaper advertisements for the quitline, one of which offered a free stop smoking guide and one that offered the guide plus a free stop smoking aide called Better Quit (BQ). Responses to each promotion were monitored by tracking the call volume to the quitline-before, during, and after each of the promotions. The NRT voucher promotion increased median call volume 25-fold compared to prepromotion levels, whereas the BQ newspaper advertisement increased median call volume 2-fold compared to a newspaper advertisement for the quitline, which did not offer BQ. A random sample of 732 smokers who received the free NRT voucher were followed up 4 to 6 months later to determine their use of NRT and smoking behavior. Embedded within this follow-up study was a randomized experiment in which half the smokers were mailed a quit kit with BQ included and the other half received just the quit kit. Seventy percent of follow-up survey respondents said that they had redeemed the NRT voucher and used the medication to try to quit smoking. Twenty-two percent reported they were no longer smoking, compared with the 12 percent among a comparison group of quitline callers who had not received the free NRT voucher (odds ratio = 1.77; 95% confidence interval: 1.17-2.68). There was no difference in quit rates between those that were sent the BQ cigarette substitute and those that did not get the BQ. This study shows that offering a free 2-week voucher for NRT is a cost-effective method to increase calls to a stop smoking quitline and may also increase the odds of quitting for those who get the free NRT.

Female↗
PubMed2006

British out-of-hours primary and community care: a review of the literature.

PURPOSE: This out-of-hours primary and community care services (more recently called unscheduled care) literature review sets out to build on the foundations set by earlier publications by examining old and fresh issues after the new General Medical Service contract was implemented in 2004. DESIGN/METHODOLOGY/APPROACH: Almost 140 publications were located, including a range of theoretical and empirical publications. FINDINGS: A total of seven themes emerge--varying from the most frequently discussed (service nature and value) to the least examined (information management and technology). ORIGINALITY/VALUE: Analysis not only underlines service problems and tensions noted previously but also generates new insights, which cannot be ignored if services are to be developed. Consequently, several recommendations are made.

After-Hours Care↗
PubMed2006

Evaluating the effectiveness of proactive telephone counselling for smoking cessation in a randomized controlled trial.

AIM: To evaluate the effectiveness of repeated-contact proactive telephone counselling for smoking cessation in a UK setting. DESIGN: Randomized controlled trial. SETTING: The Quitline, an established national telephone counselling service available throughout the UK. PARTICIPANTS AND INTERVENTION: A total of 1,457 callers to the Quitline in 2000 and 2001 were allocated randomly to a Control group to receive usual care or to a Repeated Contact group to be offered five proactive calls in addition to usual care. MEASUREMENTS Prolonged abstinence and 24-hour point-prevalent abstinence 6 and 12 months after recruitment, quit attempts and 24-hour periods of abstinence in non-quitters. FINDINGS: No significant differences were found between the Repeated Contact and Control groups on prolonged or point-prevalent abstinence. On an intention-to-treat basis, 9.5% of the Control group were abstinent for longer than 6 months at the 12-month follow-up, compared with 9.3% of the Repeated Contact group; 18.9% and 20.2%, respectively, were point-prevalent abstinent at the 6-month follow-up. Significantly more non-quitters in the Control group made a quit attempt in the first 6 months following recruitment than in the Repeated Contact group (62.6%/56.1%, P < 0.05). CONCLUSIONS Proactive telephone counselling did not significantly increase abstinence rates, and appeared to decrease quit attempts, in callers to the Quitline. A non-structured, client-led counselling protocol and insufficient pre-quit motivational counselling could account for the lack of effect.

Adult↗
PubMed1997

Evaluation of a cancer-based coping and caring course used in three different settings.

Cancer in the family may affect the psycho-social adjustment of the children involved. Children who have survived childhood cancer or with a parent or sibling with cancer, may find protection from the risk of emotional and behavioural difficulties from effective external support systems. A training course was developed by the Cancer Research Campaign to help professionals who make up potential external support systems, cope with children experiencing cancer-related life crises. The course was offered to, and evaluated with, practising teachers, student teachers and Cancer Aid and Listening Line workers. Results from interviews and pre and post course questionnaires indicated that after the course all three groups felt more confident in dealing with children under stress. Participants felt that specific skills such as 'attentive listening' had increased as a result of the course. Of the three groups the practising teachers have found the course the most useful in their work and have been able to disseminate their newly acquired skills throughout their schools. Teachers are expected to cope with students' various life crises as they arise in schools. Basic counselling skills training for teachers could help them cope with these in a more confident manner, thereby reducing the risk of emotional and behavioural difficulties and contributing towards a Health Promoting School ethos.

Adaptation, Psychological↗
PubMed1993

Psychosocial support and malignant melanoma.

The holistic care of patients with malignant melanoma requires psychosocial intervention. This paper provides an argument in support of this, based on research findings, clinical experience, demand and implications for the future. Strategies for providing psychosocial support are outlined with emphasis on a coordinated multidisciplinary approach, specialist nursing contributions and self-help. Recent innovations are described with recommendations for similar strategies to be employed in the prevention of disease and associated morbidity.

Hotlines↗
PubMed2004

Rapid assessment of a helpdesk service supporting severe acute respiratory syndrome patients and their relatives.

BACKGROUND: To contain severe acute respiratory syndrome, the Hong Kong Hospital Authority set a policy that stipulated there should be no visitors to hospital wards. A helpdesk service was established with the goal of providing immediate emotional and communication support to relatives while severe acute respiratory syndrome patients were isolated during the acute phase of the illness. AIM: This study describes the results of a rapid assessment of the effectiveness of a helpdesk service designed to meet the immediate needs of relatives of severe acute respiratory syndrome patients in Hong Kong. DESIGN: Survey. METHOD: Eighty-three respondents, representing about 46.3% of relatives (179), attending the helpdesk on the day of the study were recruited. Service evaluation data was collected using a self-administered questionnaire completed by respondents. RESULTS: Nearly 100% of respondents who used the service found the delivery service with on-site counselling useful for alleviating their anxiety. However, about half of these relatives complained of insufficient information regarding the patient's condition and progress. The majority of respondents were satisfied with the service. In describing the most important traits of the service providers, caring and enthusiasm were mentioned most frequently by respondents who stated that they were very satisfied with the service. CONCLUSION: The results support the value of the service, and demonstrate that the service is effective in meeting relatives' immediate needs. These needs include information, aid in fulfilling their role as caretaker for the patient (delivering prepared soup) and psychological support. The results suggest that facilitation of visitation of patients by relatives via video conferencing and education of the public on the nature and course of severe acute respiratory syndrome to reduce the social stigma of having a potentially life-threatening disease should be introduced in Hong Kong. RELEVANCE TO CLINICAL PRACTICE: The results highlight important attributes that helpers (nurses) should have in order to alleviate the suffering of severe acute respiratory syndrome patients and their relatives.

Adult↗