Lake Rebecca, Georgiou Andrew, Li Julie, Li Ling, Byrne Mary, Robinson Maureen, Westbrook Johanna I
Australian Digital Health Agency, Level 25, 56 Pitt Street, Sydney, NSW, 2000, Australia.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
BMC Health Serv Res. 2017 Aug 30;17(1):614. doi: 10.1186/s12913-017-2564-x.
Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS.
We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews.
Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.
Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings.
电话分诊与咨询服务（TTAS）在全球范围内的应用日益广泛。这些服务使人们能够通过电话与护士或全科医生交谈，并获得评估和医疗保健建议。关于TTAS这一主题已有一定的研究成果，但证据基础的分散性使得难以确定文献中一致的关键经验教训。系统评价代表了证据综合的最高水平。我们旨在对这些评价进行概述，以确定与TTAS的治理、安全性和质量相关的研究结果的范围、一致性和普遍性。
我们在PubMed、MEDLINE、EMBASE、CINAHL、科学网和Cochrane图书馆中检索自1990年以来发表的、聚焦于与电话分诊和咨询服务相关的关键治理、质量和安全性研究结果的英文系统评价。检索由三位研究人员进行，他们就所有纳入的系统评价达成了共识。两位研究人员使用《系统评价评估测量工具》独立对系统评价的方法学质量进行评估。
从潜在的291项结果中选取了10项系统评价纳入研究。TTAS单独接受研究，或作为旨在改善初级保健的初级保健服务模式或干预措施的一部分进行研究。在九个关键指标上报告了TTAS的表现证据——可及性、适宜性、依从性、患者满意度、成本、安全性、卫生服务利用、医生工作量和临床结果。患者对TTAS的满意度普遍较高，并且在TTAS减少临床工作量的能力方面存在一些一致的证据。TTAS安全性的测量结果倾向于表明，TTAS与传统护理之间没有重大差异。
总体而言，现有证据并未对所提供护理的质量、服务的可及性和公平性、成本及结果等问题给出明确答案。现有证据还表明，存在许多相互作用的因素（例如，与其他卫生服务提供者的关系），这些因素可能影响绩效指标，也会影响研究结果的外部有效性。
