Bunn F, Byrne G, Kendall S
Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, College Lane, Hatfield, Hertfordshire, UK, AL10 9AB.
Cochrane Database Syst Rev. 2004 Oct 18(4):CD004180. doi: 10.1002/14651858.CD004180.pub2.
Telephone consultation is the process where calls are received, assessed and managed by giving advice or by referral to a more appropriate service. In recent years there has been a growth in telephone consultation developed, in part, as a response to increased demand for General Practitioner (GP) and Accident and Emergency (A&E) department care.
To assess the effects of telephone consultation on safety, service usage and patient satisfaction and to compare telephone consultation by different health care professionals.
We searched the Cochrane Central Register of Controlled Trials, the specialised register of the Cochrane Effective Practice and Organisation of Care (EPOC) group, Pubmed, EMBASE, CINAHL, SIGLE, and the National Research Register. We checked reference lists of identified studies and review articles and contacted experts in the field. The search was not restricted by language or publication status.
Randomised controlled trials (RCTs), controlled studies, controlled before/after studies (CBAs) and interrupted time series (ITSs) of telephone consultation or triage in a general health care setting. Disease specific phone lines were excluded.
Two reviewers independently screened studies for inclusion in the review, extracted data and assessed study quality. Data were collected on adverse events, service usage, cost and patient satisfaction. Due to heterogeneity we did not pool studies in a meta-analysis and instead present a narrative summary of the findings.
Nine studies met our inclusion criteria, five RCTs, one CCT and three ITSs. Six studies compared telephone consultation versus normal care; four by a doctor, one by a nurse and one by a clinic clerk. Three studies compared telephone consultation by different types of health care workers; two compared nurses with doctors and one compared health assistants with doctors or nurses. Three of five studies found a decrease in visits to GP's but two found a significant increase in return consultations. In general at least 50% of calls were handled by telephone advice alone. Seven studies looked at accident and emergency department visits, six showed no difference between the groups and one, of nurse telephone consultation, found an increase in visits. Two studies reported deaths and found no difference between nurse telephone triage and normal care.
REVIEWERS' CONCLUSIONS: Telephone consultation appears to reduce the number of surgery contacts and out-of-hours visits by general practitioners. However, questions remain about its affect on service use and further rigorous evaluation is needed with emphasis on service use, safety, cost and patient satisfaction.
电话咨询是一个接收、评估和处理来电的过程，通过提供建议或转介到更合适的服务机构来进行管理。近年来，电话咨询有所发展，部分原因是对全科医生（GP）和急诊（A&E）部门护理的需求增加。
评估电话咨询对安全性、服务使用情况和患者满意度的影响，并比较不同医疗保健专业人员进行的电话咨询。
我们检索了Cochrane对照试验中心注册库、Cochrane有效实践与护理组织（EPOC）小组的专业注册库、PubMed、EMBASE、CINAHL、SIGLE和国家研究注册库。我们检查了已识别研究和综述文章的参考文献列表，并联系了该领域的专家。检索不受语言或出版状态的限制。
在一般医疗环境中进行电话咨询或分诊的随机对照试验（RCT）、对照研究、前后对照研究（CBA）和中断时间序列（ITS）。特定疾病的电话线被排除。
两名综述作者独立筛选纳入综述的研究，提取数据并评估研究质量。收集了关于不良事件、服务使用情况、成本和患者满意度的数据。由于存在异质性，我们未在荟萃分析中汇总研究，而是对研究结果进行了叙述性总结。
九项研究符合我们的纳入标准，五项RCT、一项CCT和三项ITS。六项研究比较了电话咨询与常规护理；四项由医生进行比较，一项由护士进行比较，一项由诊所职员进行比较。三项研究比较了不同类型医疗保健工作者进行的电话咨询；两项比较了护士与医生，一项比较了健康助理与医生或护士。五项研究中有三项发现看全科医生的次数减少，但两项发现复诊次数显著增加。一般来说，至少50%的来电仅通过电话咨询处理。七项研究观察了急诊部门就诊情况，六项显示两组之间无差异，一项关于护士电话咨询的研究发现就诊次数增加。两项研究报告了死亡情况，发现护士电话分诊与常规护理之间无差异。
电话咨询似乎减少了全科医生的门诊预约次数和非工作时间就诊次数。然而，其对服务使用的影响仍存在疑问，需要进一步进行严格评估，重点关注服务使用情况、安全性、成本和患者满意度。
