Delichatsios H, Callahan M, Charlson M
Division of General Internal Medicine at Cornell University Medical College, New York, NY, USA.
J Gen Intern Med. 1998 Sep;13(9):579-85. doi: 10.1046/j.1525-1497.1998.00179.x.
To document the outcomes of a telephone coverage system and identify patient characteristics that may predict these outcomes.
Telephone survey.
An academic outpatient medical practice that has a physician telephone coverage service.
All patients (483) who called during the 3-week study period to speak to a physician were evaluated, and for the 180 patients with symptoms, attempts were made to survey them by telephone 1 week after their initial telephone call.
The mean age of the 180 patients was 41 years, 71% were female, and 56% belonged to commercial managed care plans. In the week after the initial telephone call, the following outcomes were reported: 27% of the patients had no further contact with the practice; 9% filled a prescription medication; 19% called the practice again; 48% kept an earlier appointment in the practice; 3% saw an internist elsewhere; 8% saw a specialist; 8% went to an emergency department; 4% were admitted to a hospital. Of the 180 patients who called with symptoms, 160 (89%) were successfully contacted for survey. Eighty-seven percent of these 160 patients rated their satisfaction with the care they received over the telephone as excellent, very good, or good. In multivariate analysis, patients' own health perception identified those most likely to have symptom relief (p = .002), and symptom relief, in turn, was a strong predictor of high patient satisfaction (p = .006). Thirty-three percent of the 160 patients reported that they would have gone to an emergency department if a physician were not available by telephone.
In the present study, younger patients, female patients, and patients in commercial managed care plans used the telephone most frequently. Also, the telephone provided a viable alternative to emergency department and walk-in visits. Overall satisfaction with telephone medicine was high, and the strongest predictors of high patient satisfaction were symptom relief and patients' own health perception.
记录电话覆盖系统的结果，并确定可能预测这些结果的患者特征。
电话调查。
一家设有医生电话覆盖服务的学术门诊医疗诊所。
对在为期3周的研究期间致电找医生的所有患者（483名）进行评估，对于180名有症状的患者，在他们首次致电后1周尝试通过电话对他们进行调查。
180名患者的平均年龄为41岁，71%为女性，56%属于商业管理式医疗计划。在首次致电后的一周内，报告了以下结果：27%的患者与该诊所没有进一步联系；9%的患者开了处方药；19%的患者再次致电该诊所；48%的患者提前在该诊所预约；3%的患者去其他地方看了内科医生；8%的患者看了专科医生；8%的患者去了急诊科；4%的患者住院。在180名有症状致电的患者中，160名（89%）成功被联系进行调查。这160名患者中有87%对他们通过电话接受的护理满意度评为优秀、非常好或良好。在多变量分析中，患者自身的健康认知确定了最有可能症状缓解的患者（p = 0.002），而症状缓解反过来又是患者高满意度的有力预测因素（p = 0.006）。160名患者中有33%报告说，如果没有医生通过电话提供服务，他们会去急诊科。
在本研究中，年轻患者、女性患者和参加商业管理式医疗计划的患者最常使用电话。此外，电话为急诊科就诊和即看即诊提供了可行的替代方案。对电话医疗的总体满意度较高，患者高满意度的最强预测因素是症状缓解和患者自身的健康认知。
