在全科医疗中实施电话分诊：一项整群随机对照试验的过程评估
Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial.
作者信息
Murdoch Jamie, Varley Anna, Fletcher Emily, Britten Nicky, Price Linnie, Calitri Raff, Green Colin, Lattimer Valerie, Richards Suzanne H, Richards David A, Salisbury Chris, Taylor Rod S, Campbell John L
机构信息
School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
Primary Care Research Group, University of Exeter Medical School, Exeter, UK.
出版信息
BMC Fam Pract. 2015 Apr 10;16:47. doi: 10.1186/s12875-015-0263-4.
BACKGROUND
Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff.
METHODS
The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff).
RESULTS
Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage.
CONCLUSION
The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN20687662. Registered 28 May 2009.
背景
电话分诊是基层医疗中管理面对面全科医生预约需求的一种策略。然而，关于全科医生诊所实施电话分诊所面临挑战的证据有限。我们在一项英国集群随机试验（ESTEEM）的同时进行了定性过程评估，该试验比较了由全科医生主导和护士主导的电话分诊与常规护理对基层医疗工作量、成本、患者体验以及当日预约全科医生咨询患者安全性的影响。该过程研究的目的是从工作人员和患者的角度深入了解ESTEEM试验所观察到的效果，并明确分诊可能成功实施的情况。在此我们报告工作人员的观点。
方法
干预措施包括实施由全科医生主导或护士主导的电话分诊，为期2至3个月。使用从英国8家全科诊所（4家全科医生分诊、4家护士分诊）招募的工作人员访谈进行定性评估，这些诊所将分诊作为ESTEEM试验的一部分实施。对44名全科医生分诊和护士分诊诊所的工作人员（16名全科医生、8名护士、7名诊所经理、13名行政人员）进行了定性访谈。
结果
工作人员报告了关于电话分诊实施情况、其对工作量的影响以及分诊益处的不同经历和看法。分诊组织方式的不同、用于支持分诊的人员配备模式、分诊引入在诊所工作人员中的沟通方式以及由于实施分诊导致的工作人员角色重新配置，解释了这种多样性。
结论
过程评估的结果深入了解了参与ESTEEM的全科医生诊所实施电话分诊的多种方式，以及在临床试验背景之外电话分诊能够成功实施的情况。工作人员对电话分诊的体验和看法受到诊所与工作人员沟通方式、为有效实施分诊所需的变革做好准备并维持这些变革的方式的影响，也受到现有诊所文化以及因变革而产生的工作人员和患者行为的影响。
试验注册
当前受控试验ISRCTN20687662。2009年5月28日注册。
Zotero 插件