Can we Reduce Hospital Attendance Without Compromising Care by the Use of Telephone Consultation
Condition: Asthma; COPD; Sleep Apnea Syndromes; Interstitial Lung Diseases; Bronchiectasis
MeSH terms: Sleep Apnea Syndromes; Lung Diseases; Lung Diseases, Interstitial; Bronchiectasis
Study type: Interventional

Summary: 
      Consultation time in busy respiratory clinics is inevitably limited and attendance is often
      disruptive to patients' lives; involves time, expense, travel, and waiting; and can have
      effects upon occupation. Published work suggests that patient satisfaction with telephone
      consultations is high and this subject has recently been extensively reviewed by one of the
      study investigators. In respiratory medicine there is United States (US) data to suggest that
      the regular telephoning of adolescents with asthma by a specialist nurse can reduce
      unscheduled use of health service resources. In the United Kingdom (UK), a randomised,
      controlled trial in primary care has shown that, compared to face to face consultations, use
      of the telephone can enable greater numbers of patients with asthma to be reviewed. Another
      of the study investigators has undertaken a feasibility study in a general respiratory clinic
      and has shown the concept of alternating face to face consultation with telephone
      consultation to be acceptable to over 80% of patients. Over one third were assessed to be
      suitable in that they did not need to attend the clinic for either physical examination or
      for investigations. It is therefore proposed to evaluate the feasibility, acceptability, time
      savings and safety of the use of telephone consultation in 3 respiratory clinics in the
      Department of Respiratory Medicine at Charing Cross Hospital.
    

Detailed description: 
      Patients to be included in the study would be those attending 3 respiratory clinics. The
      patients would be asked if they were willing to have a telephone consultation instead of
      their next face to face consultation and this would be explained to them.

      "Many patients attending a Chest Clinic need to do so only once. For others their condition
      merits regular review. Most of these people need to come to the clinic because they need
      chest x-rays, blood tests or breathing tests. However some patients return for review of
      their condition without needing any specialist investigations. We are keen to assess what
      proportion of our patients would be suitable for telephone consultations rather than face to
      face consultations and to see what advantages there might be for both patients and doctors.
      We are therefore interested to assess the use of telephone consultation where suitable and
      would like to know if you would be willing to try telephone consultation for your next
      appointment. In the case of telephone consultation you would be offered a day, date and time
      at which you would be phoned. Your consultant, would then ring you him or herself within half
      an hour of the appointed time {and procedurally it has been agreed by the trial participants
      that if, for any reason, during the trial period they are delayed with the previous patient
      they will excuse themselves to telephone the following patient to say that they have been
      delayed and they will ring them back within 15 minutes, for example} and with your clinical
      notes in front of them he or she would enquire in the usual way regarding how you feel, ask
      about your symptoms and give advice regarding any concerns you may have or advise regarding
      changes in treatment. You would subsequently receive a copy of the letter summarising the
      telephone consultation when it was sent to your general practitioner. If the telephone
      consultation suggested that you needed to be seen in the clinic you would be offered an
      appointment within two weeks of the telephone call."

      Demographic details and disease diagnosis would be recorded, for those not deemed suitable or
      for those not wishing to take part and they would continue to attend traditional face to face
      consultations. Those having a telephone consultation would subsequently revert to traditional
      consultation pending results of the trial. Frequency of planned consultation would be as per
      the consultant's usual practice.

      Procedurally, it was agreed that for those patients agreeing to have their next consultation
      by telephone, the doctor would check the phone number which they wished for the investigators
      to use and this would be inserted in the notes at the end of the previous consultation with a
      large black box around it, so that it could easily be spotted at the time of the telephone
      consultation.

      For all patients the following observations would be made: length of the telephone
      consultation, fail to be available when telephoned rate, and length of each face to face
      consultation.

      For each face to face consultation the following information would be recorded: the time they
      left home; time of arrival at hospital, time spent waiting for consultation, expense of
      attendance, both travel costs but also any indirect costs such as babysitting charges and
      loss of earnings. For each telephone consultation the number of patients having to be
      reviewed within the next 2 weeks of the telephone consultation would be recorded, whether
      such expedited follow up was at the patient's or the doctor's behest.

      After both the telephone consultation and their subsequent face to face consultation the
      patients would be asked to complete the post consultation patient satisfaction questionnaire,
      the MISS 21 questionnaire and the Howie Enablement Instrument. Patients would be posted these
      scales by first class post on the day of a telephone consultation and handed them for
      completion after a face to face consultation and on each occasion they would be given a
      stamped addressed envelope in which to return the completed scores.
    

Intervention name(s): Telephone consultation
Intervention type(s): Procedure
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: phone consultation in secondary care