Partridge Martyn R
Department of Respiratory Medicine, Faculty of Medicine, NHLI Division, Imperial College London, Charing Cross Campus, St. Dunstans Road, London W6 8RP, UK.
Patient Educ Couns. 2004 Jul;54(1):11-3. doi: 10.1016/S0738-3991(03)00166-6.
One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.
我们询问了164名连续就诊于繁忙呼吸门诊的患者，了解他们对面对面咨询与电话或电子邮件咨询交替进行这一概念的接受程度。然后评估这些患者是否适合采用这种非传统的咨询方式。30名患者（18.3%）不同意采用其他形式的咨询，5名患者不会说英语。133名患者（84%）有适合咨询的白天电话号码，但只有34名患者（21%）可以使用电子邮件，且这在年轻人中更为常见。105名患者因病情严重、通过电话评估病情困难或需要到医院进行检查而被认为不适合采用替代咨询方法。然而，即使在一个已经将尽可能多的患者转回初级保健医生处治疗的诊所，以及一个已经与呼吸护士专家分担了大量工作的诊所，仍有超过三分之一的患者被认为适合面对面咨询与电话咨询交替进行。这些病例的诊断包括哮喘、疑似阻塞性睡眠呼吸暂停、慢性阻塞性肺疾病（COPD）、不明原因咳嗽，以及一些姑息治疗服务在家中探访的呼吸恶性肿瘤患者。然而，对于哮喘患者以及尤其是等待检查结果的患者来说，电话咨询似乎是一种可接受且方便的方式，可以减轻面对面咨询可用时间的压力。
