Effectiveness of telephone consultations for fever or gastroenteritis using a formalised procedure in Emergency Medical Communication Centre: A cluster randomised controlled trial
Resumen
Objective: To determine the effectiveness of formalised telephone medical advice (fTMA), provided by a physician for fever or gastroenteritis in out-of-hours.
Methods: We performed a cluster pragmatic randomised controlled trial and economic evaluation over 12 months. Patients were randomly assigned to either fTMA given by a general practitioner (GP) or usual care. Six French Emergency Medical Communication Centres serving 5.8 million patients participated. We enrolled patients contacting the out-of-hours service for assistance with fever or gastroenteritis. In the experimental arm, fTMA offered reassurance, explanations and advice on therapeutic management, which may include a telephone prescription. The primary endpoint was the percentage of patients with an out-of-hours face-to-face consultation with a GP, or who were admitted to hospital, during the two weeks following their call. Secondary endpoints were the healthcare pathway, clinical outcome and economic analysis.
Results: 2,498 callers (1,234 in the intervention group) were included. Patients in the fTMA group were significantly less likely to be admitted to hospital or receive an out-of-hours face-to-face GP consultation at day 15; relative risk -0.36 (95% CI -0.55 to -0.16). There was no significant difference between the two groups regarding ambulance intervention, intensive care admission, mortality or morbidity, improvement of symptoms. During the two-week survey, the average total cost was €91 ± 457 in the fTMA group vs. €150 ± 644 in the usual care group (p<0.01).
Conclusions: Introduction of fTMA was associated with a decrease in out-of-hours face-to-face consultations with a GP, or admission to hospital. This procedure is safe, effective and is associated with lower cost compared to usual practice.
Palabras Clave
Kontopantelis E, Roland M, Reeves D. Patient experience of access to primary care: identification of predictors in a national patient survey. BMC Fam Pract. 2010 Aug 28;11:61.
Campbell JL, Fletcher E, Britten N, Green C, Holt TA, Lattimer V, et al. Telephone triage for management of same-day consultation requests in general practice (the ESTEEM trial): a cluster-randomised controlled trial and cost-consequence analysis. Lancet Lond Engl. 2014 Nov 22;384(9957):1859–68.
Bunn F, Byrne G, Kendall S. Telephone consultation and triage: effects on health care use and patient satisfaction. Cochrane Database Syst Rev. 2004;(4):CD004180.
Vaona A, Pappas Y, Grewal RS, Ajaz M, Majeed A, Car J. Training interventions for improving telephone consultation skills in clinicians. Cochrane Database Syst Rev. 2017 05;1:CD010034.
Holt TA, Fletcher E, Warren F, Richards S, Salisbury C, Calitri R, et al. Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial. Br J Gen Pract J R Coll Gen Pract. 2016 Mar;66(644):e214-218.
Lattimer V, Sassi F, George S, Moore M, Turnbull J, Mullee M, et al. Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial. BMJ. 2000 Apr 15;320(7241):1053–7.
McKinstry B, Walker J, Campbell C, Heaney D, Wyke S. Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices. Br J Gen Pr. 2002 Apr;52(477):306–10.
Thompson F, George S, Lattimer V, Smith H, Moore M, Turnbull J, et al. Overnight calls in primary care: randomised controlled trial of management using nurse telephone consultation. BMJ. 1999 Nov 27;319(7222):1408.
Lattimer V, George S, Thompson F, Thomas E, Mullee M, Turnbull J, et al. Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial. The South Wiltshire Out of Hours Project (SWOOP) Group. BMJ. 1998 Oct 17;317(7165):1054–9.
Labarere J, Torres JP, Francois P, Fourny M, Argento P, Gensburger X, et al. Patient compliance with medical advice given by telephone. Am J Emerg Med. 2003 Jul;21(4):288–92.
Greffet A, Rouillard A, Ek F, Borgne N, Szmajer M, Sauval P, et al. Démarche qualité en médecine d’urgence: évaluation du ressenti de la population prise en charge à domicile par le Samu de Paris. JEUR. 2007;20:106–12.
Sinturet I, Mercier N. Mise en place d’une fiche d’évaluation téléphonique et de fiches de conseils téléphoniques aux urgences de pédiatrie. JEUR. 2006;A242.
Vartanian C, Leseur A, Libaud B, Letoumelin P, Leclercq G, Bouvet F. Conseils téléphoniques au centre 15 de la Seine-Saint-Denis. Rev Samu. 2006;1:325–30.
Reuter P-G, Desmettre T, Guinemer S, Ducros O, Begey S, Ricard-Hibon A, et al. Effectiveness and cost-effectiveness of telephone consultations for fever or gastroenteritis using a formalised procedure in general practice: study protocol of a cluster randomised controlled trial. Trials. 2016 Sep 22;17(1):461.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2013 Apr;16(2):e1-5.
O’Brien BJ, Briggs AH. Analysis of uncertainty in health care cost-effectiveness studies: an introduction to statistical issues and methods. Stat Methods Med Res. 2002 Dec;11(6):455–68.
Briggs AH, O’Brien BJ. The death of cost-minimization analysis? Health Econ. 2001 Mar;10(2):179–84.
Jiwa M, Mathers N, Campbell M. The effect of GP telephone triage on numbers seeking same-day appointments. Br J Gen Pr. 2002 May;52(478):390–1.
Richards DA, Meakins J, Tawfik J, Godfrey L, Dutton E, Richardson G, et al. Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs. BMJ. 2002 Nov 23;325(7374):1214.
Munro J, Nicholl J, O’Cathain A, Knowles E. Impact of NHS direct on demand for immediate care: observational study. BMJ. 2000 Jul 15;321(7254):150–3.
O’Cathain A, Munro JF, Nicholl JP, Knowles E. How helpful is NHS direct? Postal survey of callers. BMJ. 2000 Apr 15;320(7241):1035.
Car J, Sheikh A. Telephone consultations. BMJ. 2003 May 3;326(7396):966–9.
Campbell JL, Fletcher E, Britten N, Green C, Holt T, Lattimer V, et al. The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial). Health Technol Assess Winch Engl. 2015 Feb;19(13):1–212, vii–viii.