Lee Thomas J, Guzy Judith, Johnson David, Woo Heide, Baraff Larry J
Emergency Medicine Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Pediatrics. 2002 Nov;110(5):865-72. doi: 10.1542/peds.110.5.865.
To compare caller satisfaction with after-hours medical advice provided by a for-profit nurse advice service with advice provided by on-call pediatricians.
The study setting was the general pediatrics faculty practice of an urban university medical center. Participants were parents or guardians of a population of approximately 6000 children calling for after-hours medical advice over a 10-month period from January 18 to November 20, 2000. After-hours medical advice calls were randomized to either a nurse advice service or the on-call pediatrician. Caller satisfaction and subsequent health care utilization were measured by a telephone survey of callers and review of all health care visits within 3 days of the initial telephone advice call.
Five hundred sixty-six (48%) callers were enrolled in the on-call pediatrician group, and 616 (52%) were enrolled in the advice nurse group. Caller satisfaction was rated as very good or excellent significantly more often for the on-call pediatrician than for the nurse advice service as follows: telephone call overall (68.5% vs 55.0%; 95% confidence interval [CI] of difference: 8.0%-19.0%), thoroughness and competence of the person they spoke with (74.0% vs 59.1%; 95% CI of difference: 9.6%-20.2%), courtesy and friendliness of the person they spoke with (77.4% vs 73.9%; 95% CI of difference: -1.4%-8.4%), length of time spent waiting (70.8% vs 60.1%; 95% CI of difference: 5.4%-16.2%), time spent talking with the on-call pediatrician or advice nurse (68.2% vs 52.4%; 95% CI of difference: 10.2%-21.3%), and the medical advice given (68.6% vs 53.9%; 95% CI of difference: 9.2%-20.1%). Compliance with the advice given was significantly higher for office care in the on-call pediatrician group (51.5% vs 29.6%; 95% CI of difference: 8.9%-34.2%). Repeat calls for advice were significantly more frequent for the nurse advice service, both within 4 hours (13.0% vs 4.8%; 95% CI of difference: 5.0%-11.4%), and within 72 hours (23.4% vs 13.3%; 95% CI of difference: 5.8%-14.5%).
Callers were less satisfied with medical advice provided by a nurse advice service compared with the traditional on-call pediatrician. The lower satisfaction was associated with somewhat poorer compliance with recommended triage dispositions and more frequent repeat calls for medical advice.
比较营利性护士咨询服务提供的非工作时间医疗建议与随叫随到的儿科医生提供的建议，看哪一种更让来电者满意。
研究地点为一所城市大学医学中心的普通儿科教职员工诊所。参与者是2000年1月18日至11月20日这10个月期间为非工作时间医疗建议致电的约6000名儿童的家长或监护人。非工作时间的医疗建议电话被随机分配给护士咨询服务或随叫随到的儿科医生。通过对来电者进行电话调查以及查阅首次电话咨询建议后3天内所有的医疗就诊记录，来衡量来电者满意度和后续医疗保健利用情况。
566名（48%）来电者被纳入随叫随到的儿科医生组，616名（52%）被纳入咨询护士组。与护士咨询服务相比，随叫随到的儿科医生的来电者满意度被评为非常好或优秀的比例显著更高，具体如下：总体电话咨询（68.5%对55.0%；差异的95%置信区间[CI]：8.0%-19.0%）、与他们交谈之人的彻底性和能力（74.0%对59.1%；差异的95%CI：9.6%-20.2%）、与他们交谈之人的礼貌和友好程度（77.4%对73.9%；差异的95%CI：-1.4%-8.4%）、等待时间长度（70.8%对60.1%；差异的95%CI：5.4%-16.2%）、与随叫随到的儿科医生或咨询护士交谈的时间（6
