McKinstry B, Hammersley V, Burton C, Pinnock H, Elton R, Dowell J, Sawdon N, Heaney D, Elwyn G, Sheikh A
Centre of Population Health Sciences: General Practice Section, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DR, UK.
Qual Saf Health Care. 2010 Aug;19(4):298-303. doi: 10.1136/qshc.2008.027763. Epub 2010 Apr 29.
Telephone consulting is increasingly used to improve access to care and optimise resources for day-time work. However, there remains a debate about how such consultations differ from face-to-face consultations in terms of content quality and/or safety. To investigate this, a comparison of family doctors' telephone and face-to-face consultations was conducted.
106 audio-recordings (from 19 doctors in nine practices) of telephone and face-to-face consultations, stratified at doctor level, were compared using the Roter Interaction Analysis Scale (RIAS) (content measure), the OPTION (observing patient involvement in decision making scale) and a modified scale based on the Royal College of General Practitioners (RCGP) consultation assessment instrument (measuring quality and safety). Patient satisfaction and enablement were measured using validated instruments. The Roter Interaction Analysis Scale scores were compared by multiple linear regression adjusting for covariates; other continuous measures by chi(2) and Student t tests and binary measures as odds ratios.
Telephone consultations were shorter (4.6 vs 9.7 min, p<0.001), presented fewer problems (1.2 vs 1.8, p<0.001) and included less data gathering, counselling/advice and rapport building (all p<0.001) than face-to-face consultations. These differences remained significant when consultation length and number of problems were taken into account. Telephone consultations were judged less likely to include sufficient information to exclude important serious illnesses. Patient involvement and satisfaction outcomes were similar in both consultation types.
Although telephone consultations are convenient and judged satisfactory by patients and doctors, they may compromise patient safety more than face-to-face consultations and further research is required to elucidate this. Telephone consultations may be more suited to follow-up and management of long-term conditions than for in-hours acute management.
电话咨询越来越多地被用于改善医疗服务的可及性，并优化日间工作资源。然而，在内容质量和/或安全性方面，此类咨询与面对面咨询如何不同仍存在争议。为了对此进行调查，我们对家庭医生的电话咨询和面对面咨询进行了比较。
使用罗特互动分析量表（RIAS）（内容测量）、OPTION（观察患者参与决策制定量表）以及基于皇家全科医师学院（RCGP）咨询评估工具的改良量表（测量质量和安全性），对106份电话咨询和面对面咨询的录音（来自9家诊所的19名医生）进行比较，这些录音在医生层面进行了分层。使用经过验证的工具测量患者满意度和赋权情况。通过对协变量进行调整的多元线性回归比较罗特互动分析量表得分；其他连续测量指标通过卡方检验和学生t检验进行比较，二元测量指标作为比值比。
与面对面咨询相比，电话咨询时间更短（4.6分钟对9.7分钟，p<0.001），提出的问题更少（1.2个对1.8个，p<0.001），并且数据收集、咨询/建议和建立融洽关系的内容更少（所有p<0.001）。在考虑咨询时长和问题数量后，这些差异仍然显著。电话咨询被认为包含足够信息以排除重要严重疾病的可能性较小。两种咨询类型中患者的参与度和满意度结果相似。
尽管电话咨询方便且患者和医生都认为令人满意，但与面对面咨询相比，它们可能对患者安全造成更多损害，需要进一步研究以阐明这一点。电话咨询可能更适合长期病症的随访和管理，而不是用于工作时间内的急性处理。
