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PubMed2005

Help on the line: telephone-triage use, outcomes, and satisfaction within an uninsured population.

Telephone triage programs have been shown to be cost-effective and favorably utilized by insured populations. However, there are 45 million Americans who are uninsured and who do not have access to telephone nursing. A telephone triage service was piloted for local uninsured residents. Within the 17-month trial period, 320 calls were received, representing 207 clients. This study reports on the results of the telephone survey with a cross-sectional sample of uninsured triage patrons (N = 80). One half reported they would have sought other medical care if the telephone triage service had not been available. Most callers (98%) believed that their health care concern was understood. Moreover, 98% agreed with the advice given, and 90% reported following up on the advice given. Overall satisfaction by the uninsured population with the telephone-based nurse triage service was positive and appears to be an effective and acceptable tool by those uninsured individuals who utilized its services.

Adult↗
PubMed1999

A method to obtain a randomized control group where it seems impossible. A case study in program evaluation.

Randomization of program participants into control and experimental groups is often not feasible in field settings. The researcher's desire to evaluate a program with a rigorous experimental design is often incompatible with the objective of serving the expressed needs of the program participants. However, opportunities do arise when a randomized control group can be constructed without disregarding the participants' wish to be included in the treatment group. This article describes a method that uses the participants' compliance to program instructions as a means of classifying participants and, thereby, obtains a randomized control group for a subset of participants. A large smoking intervention project is used to illustrate two variations of this method.

Algorithms↗
PubMed2002

Evaluating quality of telehealth advice nursing.

Despite an increased interest in advice nursing, the quality of care has not been addressed. This article examines the quality of the nursing process (including problem identification, care planning, intervention, and evaluation) and its relationship to patient (consumer) outcomes. A sample of 157 nonredundant telephone calls from adults with medical-surgical problems were audiotaped, with providers' and callers' consent, and were rated through an implicit review method by registered nurse raters. The quality of the nursing process was found to be the best in the area of intervention. Patient (consumer) satisfaction was high with 95.4% of the consumers rating the calls as completely or at least somewhat satisfying, and 93.2% stating the advice was very or somewhat helpful. This study pioneers a way to rate the quality of advice nursing and lays the groundwork for further investigations of health care provider behavior and consumer outcomes.

Adult↗
PubMedDate not supplied

Decision-making strategies for telephone triage in emergency medical services.

Decision-making strategies used by nurses in telephone triage involving public emergency calls for medical help were investigated as a function of task urgency and complexity in the real-world dynamic environment. The sample included 34 nurses as call receivers. Transcripts of 50 nurse-client dialogues and 50 explanations of the decision-making process, elicited immediately after completion of the calls, were analyzed using methods of discourse and protocol analyses. In high-urgency situations, heuristic rules based on symptoms were used, and the decisions were mostly accurate. With the increase in problem complexity, more causal explanations were found, and the decisions were more often inaccurate. Furthermore, the explanations supporting the accurate decisions were often inaccurate, showing a decoupling of knowledge and action. Alternate strategies were used in moderate- to low-urgency conditions, where contextual knowledge of the situations was exploited to identify the needs of the clients and to negotiate the best plan of action to meet these needs, resulting in more accurate decisions.

Decision Support Techniques↗
PubMed1993

The UR hot line: purpose and process.

Institutions embarking on utilization endeavors require mechanisms to identify and quantitate institution-specific problems. This article describes, with examples, the application of a utilization hot line as a cost-effective tool to focus efforts and solve immediate problems.

Boston↗
PubMed2005

Calls to an inner-city hospital breastfeeding telephone support line.

Support for breastfeeding mothers after they leave the hospital is often inadequate in low-income, inner-city areas where few resources are available. In becoming a Baby-Friendly Hospital, inner-city Boston Medical Center established a breastfeeding telephone support line to overcome this discrepancy. Records of support line calls for the first 5 years of operation were reviewed to record the level of need and determine reasons for use. A total of 1959 calls for 2482 reasons were received between January 1999 and December 2003. The most common reason for calling was "need help obtaining a breast pump" or "need information about breast pumps" (44%; 1096/2482), followed by "breast issue" (7%; 181/2482) and "milk supply question" (7%; 167/2482). The results indicate that inner-city women seek breastfeeding support and demonstrate a substantial need for breast pumps. These findings suggest that the lack of breast pumps may be a barrier to continued breastfeeding for inner-city breastfeeding women.

Adult↗
PubMed1997

Support of breastfeeding through telephone counseling in Korea.

This study analyzed the problems of breastfeeding mothers who used a telephone consultant for advice. In one South Korean metropolitan area, 92 breastfeeding mothers received telephone consultation between August 24, 1994 and June 30, 1995. Mothers learned about the availability of the consultant from UNICEF, hospitals, and the general media. Problems were grouped into 11 categories (and 22 nursing diagnoses) the most common of which was breast milk insufficiency (22 cases). Fourteen mothers sought consultation about their infants' diarrhea or frequent stools. The findings in this study have practical implications for breastfeeding promotion and education in Korea.

Adult↗
PubMed2002

Use of protocols and guidelines by telephone nurses.

Changes in health care delivery, specifically the addition of telephone advice, affect how nurses work and how patients perceive care. It is important to understand the resources available to these nurses, the process by which they provide care, and patient outcomes. This descriptive study describes one type of resource, the availability and use of protocols. It also describes relationships between protocols and the quality of the nursing process and patient outcomes. Two-hundred-three taped calls to 32 advice RNs and 156 patient follow-up calls were used to measure protocol usage, nursing process quality, and patient outcomes. Although protocols were available for 78.8% of the calls, nurses varied in their extent of use (63.9% not fully used). There was a negative relationship (r = -0.395, p < 0.000) between the availability of protocols and overall quality of the nursing process. Protocol availability and use did not affect patient outcomes.

Adult↗
PubMed2003

Promoting culturally competent care for gay youth.

Gay youth and those questioning their sexual identity have been referred to as "hidden," "invisible," "stigmatized," and "marginalized." As a result, the unique safety and health needs of this subculture have been overlooked, or worse, ignored, placing these youth at risk. Because school nurses have been identifying at-risk populations of students and developing programs to promote youth and family health for years, they should be prepared to provide health care for the subculture of gay youth. However, nurses are saying they do not have the knowledge or skills needed to identify and address the needs of this group. Providing school nursing care for gay youth requires the school nurse to be culturally competent. School nurses need to be aware of, sensitive to, and knowledgeable about the subculture. They must also possess communication skills required to relate appropriately to this group. This article presents information and nursing strategies that will promote the safety and health of gay youth while enhancing the school nurse's cultural competence.

Adolescent↗
PubMed1997

Consumer requests for information regarding psychotropic drugs: experience from a national medicines phone-in.

OBJECTIVE: To undertake a qualitative analysis of calls regarding psychotropic drugs that were received during a national medicines phone-in day. BACKGROUND: In July 1996, The Society of Hospital Pharmacists of Australia coordinated a national medications phone-in day, allowing consumers to seek information about medications from pharmacists and physicians using a toll-free telephone number. METHODS: Data collection forms were used to record the details of all calls answered during the phone-in day. Demographic data collected included the estimated age and gender of the caller. Other data collected included the drugs that were the subject of the inquiry and the category of questions. RESULTS: There were 42,096 attempted connections to the service, but because of limited telecommunications capacity, only 2245 callers were successfully connected. Psychotropic drugs were the primary subject of 367 calls, representing 16.4% of all inquiries for which data collection forms were completed. Antidepressants (56.1%) and benzodiazepines (24.8%) were the two most commonly encountered classes of psychotropic drugs. The greatest proportion of calls (57.2%) was related to adverse effects of medications. The nature of the inquiries regarding adverse drug effects was generally consistent with the adverse effects detailed in the scientific literature. CONCLUSIONS: The results of this 1-day, consumer-oriented drug information project suggest that there is a substantial need for this type of service. Patients treated with psychotropic medications should have access to unbiased, high-quality information about drug therapy.

Adult↗
PubMed1994

Implementation and acceptance of outreach telephone counseling for smoking cessation with nonvolunteer smokers.

Brief supportive telephone counseling is a promising adjunct to self-help smoking cessation programs. This article reports rates of participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization. Eighty-six percent of smokers accepted at least one of three counselor calls; 66% accepted all three calls. Baseline characteristics associated with acceptance of calls included being female and greater average length of time to the first cigarette of the day. Acceptance did not differ significantly by stage of cessation. First calls with smokers who accepted all three calls were longer and were more likely to be with smokers who were willing to take a specific next action step. Overall, 12% of the sample reported having quit smoking by the third counseling call, with the highest quit rate (23%) among smokers who, at baseline, were planning to quit in the next month. Implications for large-scale interventions with smokers in health care and other organizations are discussed.

Adult↗
PubMed2005

Bases for assessments made by telephone advice nurses.

Telephone advice nursing includes triage, advice, referral, information and coordination. The aim of the study was to explore what telephone nurses base their assessments on. We conducted 14 interviews with seven telephone nurses at a health-care call centre in Sweden. Two authentic calls per nurse were used in stimulated recall interviews, where the nurses commented on the basis for their assessments. A qualitative manifest content analysis was employed. Three major categories emerged in the analysis: care-seeker, e.g. 'symptomatic sounds'; nurse, e.g. 'nurse's own experience'; and organization, e.g. 'health-care accessibility'. The findings show that the telephone advice nurses' bases for assessments appear to be very broad. They include both verbally and nonverbally communicated information, and care-seeker-, nurse- and certain organization-related factors influence the assessments. We found that an individualistic view of the care-seeker seems to dominate the assessments in non-urgent calls to a health-care call centre.

Communication↗
PubMed1995

A comparison of personal response services in Canada and the UK.

Personal response services operating over public telephone networks are now widespread in Western Europe and North America. They serve the needs of a million people in the UK and a further two to three million elsewhere. While most clients are elderly, the scope of such services is extending to people with support needs of all ages, especially where there are medical risks or a likelihood of falls. Such services are, therefore, on a convergent course with those concerned with telemedicine. A study of two personal response services was carried out, one based in Ottawa (Canada) and the other in Oldham (UK). The parallels and contrasts were examined through a survey involving personal interviews with samples of clients. Thirty-eight valid personal interviews were completed, 20 in Ottawa and 18 in Oldham, representing 14% and 53% respectively of all service clients in the survey areas. It is concluded that services established within the health sector (such as many in Canada) are better placed to accommodate change. Convergence with telemedicine will, as a result, be facilitated. In the UK, health authorities and trusts are likely to develop their own telemedicine services in competition with current providers of personal response services, thus delaying convergence.

Adult↗