McKinstry Brian, Walker Jeremy, Campbell Clare, Heaney David, Wyke Sally
Lothian Primary Care Research Network, Department of Community Health Sciences, University of Edinburgh.
Br J Gen Pract. 2002 Apr;52(477):306-10.
General practitioners (GPs) in the United Kingdom have recently begun to adopt the use of telephone consultation during daytime surgery as a means of managing demand, particularly requests for same-day appointments. However, it is not known whether the strategy actually reduces GP workload.
To investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations.
Randomised controlled trial.
All patients (n = 388) seeking same-day appointments in each surgery in two urban practices (total population = 10,420) over a four-week period.
The primary outcome measure was use of doctor time for the index telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future.
Telephone consultations took less time (8.2 minutes versus 6.7 minutes; diff = 1.5, 95% confidence interval [CI] = 0.6 to 2.4, P = 0.002). Patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed (0.6 consultations versus 0.4 consultations; diff = 0.2, 95% CI = 0.0 to 0.3, P = 0.01). Blood pressure was measured more often in the group of patients managed face-to-face (25/188 [13.3%] versus 12/181 [6.6%]; diff = 6.7%, 95% CI = 0.6% to 12.7%). There was no significant difference in patient perceptions or other secondary outcomes.
Use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.
英国的全科医生（GP）最近开始在日间门诊采用电话咨询作为管理需求的一种方式，特别是针对当日预约的请求。然而，尚不清楚该策略是否真的能减轻全科医生的工作量。
研究电话咨询的使用如何影响当日预约请求的管理、资源利用、临床护理指标以及患者对咨询的看法。
随机对照试验。
在四周时间内，两个城市诊所（总人口 = 10420）中每个诊所寻求当日预约的所有患者（n = 388）。
主要结局指标是用于首次电话或面对面咨询的医生时间。次要结局包括咨询后两周内后续检查和服务的使用情况、血压测量频率和抗生素处方数量，以及咨询时考虑的问题数量。通过患者赋能工具（PEI）测量患者的看法，并报告患者未来使用电话咨询的意愿。
电话咨询花费的时间更少（8.2分钟对6.7分钟；差值 = 1.5，95%置信区间[CI] = 0.6至2.4，P = 0.002）。通过电话咨询的患者在接下来的两周内更频繁地再次咨询全科医生（0.6次咨询对0.4次咨询；差值 = 0.2，95%CI = 0.0至0.3，P = 0.01）。面对面管理的患者组中血压测量更频繁（25/188 [13.3%]对12/181 [6.6%]；差值 = 6.7%，95%CI = 0.6%至12.7%）。患者看法或其他次要结局没有显著差异。
使用电话咨询进行当日预约可节省时间，且不会导致PEI得分降低。然而，这种短期节省可能被更高的再次咨询率和较少的机会性健康促进利用所抵消。
