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PubMedDate not supplied

Nurse-initiated telephone follow-up after acute myocardial infarction: a pilot study.

OBJECTIVES: To determine the receptivity of patients with acute myocardial infarction and their spouses to postdischarge follow-up telephone calls from a nurse, and to describe the content of nurse-patient/spouse telephone conversation during early convalescence at home. DESIGN: Descriptive pilot study using qualitative methods. SETTING: University medical center and home. SAMPLE: Twenty-one male patients with acute myocardial infarction and their wives who agreed to participate in the study. RESULTS: All subjects were receptive to telephone follow-up by cardiac nurse clinicians. From data analysis of telephone calls, five content themes emerged. These included (1) difficulty accepting changed health status, (2) reports of attempts at risk factor reduction, (3) concern for financial difficulties, (4) dealing with uncertainty, and (5) expression of appreciation for the nurse-initiated telephone call. Nurse investigators provided information and emotional support and made referrals. CONCLUSIONS: Further research should be done to test the feasibility and effectiveness of nurse-initiated telephone follow-up after hospital discharge for acute myocardial infarction in reducing patient and spouse stress and increasing patient/spouse information about self-care regimens. The clinical trial should also determine whether telephone follow-up by nurse increases patient satisfaction with the health care delivery system.

Adult↗

PubMed1991

Dispatcher-assisted telephone CPR: common delays and time standards for delivery.

STUDY OBJECTIVES: To determine the rate of bystander CPR before and after implementation of a telephone CPR program in King County; to determine the reasons for dispatcher delays in identifying patients in cardiac arrest in delivering CPR instructions over the telephone; and to suggest time standards for delivery of the telephone CPR message. DESIGN: An ongoing cardiac arrest surveillance system to calculate the annual bystander CPR rates from 1976 through 1988. Two hundred sixty-seven taped recordings of calls reporting cardiac arrests to nine emergency dispatch centers during 1988 were reviewed and timed. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Two hundred sixty-seven persons with out-of-hospital cardiac arrests receiving emergency medical services. Arrests in doctors' offices, clinics, or nursing homes were excluded. INTERVENTIONS: Dispatcher-assisted telephone CPR. MEASUREMENTS AND MAIN RESULTS: The rate of bystander CPR increased from 32% (1976 through 1981) to 54% (1982 through 1988) after implementation of the dispatcher-assisted telephone CPR program, although an increase in survival could not be demonstrated. The median time for dispatchers to identify the problem was 75 seconds; to deliver the early protocols, 19 seconds; to deliver the ventilation instructions, 25 seconds; and to deliver compression instructions, 30 seconds. The total time to deliver the entire CPR message was 2.3 minutes. The most frequent cause for delay was unnecessary questions (57%) with questions about patient age asked most frequently (32%). Other causes included the caller not being near the patient (29%) and deviations from protocol (22%). CONCLUSION: In a metropolitan emergency medical services system, a dispatcher-assisted telephone CPR program was associated with an increase in bystander CPR. Delays in proper delivery of telephone CPR can be minimized through training.

Emergency Medical Service Communication Systems↗

PubMed2000

Telephone follow-up in a randomized controlled trial in a less developed country: feasibility, validity and representativeness.

Telephone follow-up would offer considerable advantages over other modes of follow-up in less developed countries, if it were feasible and the findings were valid and generalizable. Telephone follow-up was assessed in the context of a randomized controlled trial of chest radiography in South African children. Hospital-based clinical outcomes were measured from hospital records, and also by telephone, in a subset of the same patients who offered a contact telephone number. Of 398 subjects offering a telephone number 308 (77.4%) were followed to recovery or for 28 days. Kappa statistics for a subsequent hospital visit, hospital admission, and chest radiograph were 0.88, 0.83, and 0.56, respectively. The effect of chest radiography did not differ significantly in participants accessible and not accessible by telephone. Telephone follow-up was feasible and produced valid and generalizable results at low cost.

Child↗

PubMed2000

Alternative strategies for selecting population controls: comparison of random digit dialing and targeted telephone calls.

PURPOSE: This project was carried out to identify a valid framework for selecting controls to be used in a population-based case-control study of breast cancer, and to compare participation rates and characteristics between women contacted using a standard random digit dialing (RDD) strategy and those who were sent a letter of presentation prior to telephone contact (targeted telephone calls, TTC). METHODS: Twelve hundred women, ages 20-74, were sampled from the Department of Motor Vehicles (DMV) and Health Care Financing Administration (HCFA) records. Women for whom telephone numbers were obtained (N = 771) were randomly assigned to RDD or TTC. The respondents participated in a brief telephone interview. Odd ratios (OR) and their 95% confidence intervals (CI) were used to estimate differences in characteristics of the respondents between the two contact strategies. RESULTS: Telephone numbers were obtained for 79% of women aged > or = 55 years and for only 38% of women aged < 55 years. Interviews were obtained for 48% of women for whom we obtained telephone numbers, and for 77% of women for whom eligibility was confirmed via telephone contact. Participation of target women appeared to be higher for the TTC than the RDD group (42% vs. 35%, p = 0.054). Among respondents who were > or = 55 years old, those in the TTC group were 80% more likely (OR = 1.8, 95% CI: 0.9-3.4) to report a serious medical condition than women in the RDD group, 60% less likely (OR = 0.4, 95% CI: 0.2-1.0) to report having used oral contraceptives, and 80% less likely (OR = 0.2, 95% CI: 0.1-0.5) to report having had breast surgery. CONCLUSIONS: Characteristics of respondents differed according to method of contact. These differences, along with the sampling frame used, should be considered when interpreting findings of case-control studies.

Adult↗

PubMed2006

Recognition of simulated telephone speech by cochlear implant users.

PURPOSE: To evaluate cochlear implant users' understanding of telephone speech. METHOD: Telephone speech was simulated by band-limiting broadband speech stimuli. Multitalker vowel, consonant, and sentence recognition was measured for both simulated telephone speech and broadband speech in 10 postlingually deafened adult cochlear implant users. The study was approved by the St. Vincent's Hospital institutional review board, and signed, informed consent was obtained from all participants. RESULTS: There was no significant difference in vowel recognition scores between broadband and telephone speech. However, mean consonant and sentence recognition scores were significantly poorer with telephone speech. CONCLUSIONS: The limited telephone bandwidth significantly reduced cochlear implant users' understanding of telephone speech. The effect of band-limited speech was highly variable, suggesting that the contribution of high-frequency information to speech recognition varied significantly among the cochlear implant users.

Adult↗

PubMed2002

'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services.

'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.

Attitude of Health Personnel↗

PubMedDate not supplied

Telephone prescreening enhancing a model for proactive healthcare practice.

PURPOSE: This article explicates the process of developing and implementing a contemporary, innovative program using the telephone as a tool for prescreening newly diagnosed cancer patients before their arrival at the cancer center. As another element of existing models of psychosocial care, this service lays the foundation for the efficient delivery of clinical social work services. DESCRIPTION OF PROGRAM: In the Surgical Oncology Clinic of the M.D. Anderson Cancer Center in Houston, Tex, 28 patients were contacted as part of a telephone prescreening model of a practice program from February 1, 1995 through March 31, 1995. Using a structured telephone interview format, two clinic social workers contacted patients and provided information on social work services. Patients needing resource assistance were provided with community referrals. Using the information from the telephone call, a brief outpatient assessment was completed for each patient before his or her arrival at the clinic. During the initial clinic visit, each new patient was met by the social worker to conduct a qualitative interview and address specific treatment-related concerns. OUTCOME OF PROGRAM: The patients expressed their appreciation of the interest of the social work staff and their satisfaction with the information provided. In addition, obtaining patient information and identifying patient needs before the initial visit allowed social workers to use clinic time more efficiently. Because of restructuring, the Surgical Oncology Clinic was eliminated and use of the intervention suspended. Based on the encouraging results of the telephone prescreening model of care program, reinstating the program in the future would include expanding its hours of operation to reach individuals who are not at home during the hours of 8:00 am 25:00 pm and including language assistance to address the needs of the increasingly multicultural population. CLINICAL IMPLICATIONS: Telephone prescreening is one strategy for personalizing psychosocial assessment. In this era of outpatient day surgery and cost-controlled managed healthcare, the benefits of prescreening are empowerment for both patients and multidisciplinary team members. The future holds promise for telephone prescreening to become part of the collaborative clinical pathways model of the disease-site centers concept.

Adult↗

PubMed1998

Diagnosing delirium by telephone.

To determine whether delirium can be diagnosed by telephone, we interviewed 41 subjects aged 65 years or older 1 month after repair of hip fracture, first by telephone and then face-to-face. Interviews included the modified telephone Mini-Mental State Examination and the Delirium Symptom Interview. Delirium was diagnosed using the Confusion Assessment Method diagnostic algorithm, and the telephone results were compared with the face-to-face results (the "gold standard"). Of 41 subjects, 6 were delirious by face-to-face assessment; all 6 were delirious by telephone (sensitivity 1.00). Of 35 patients not delirious by face-to-face assessment, 33 patients were not delirious by telephone (specificity = 0.94). We conclude that telephone interviews can effectively rule out delirium, but the positive diagnosis should be confirmed by a face-to-face assessment, especially in populations with a low prevalence of delirium.

Aged↗

PubMed2000

Telephone medicine for internists.

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields.

Ambulatory Care↗

PubMed2001

Cellular-telephone use and brain tumors.

BACKGROUND: Concern has arisen that the use of hand-held cellular telephones might cause brain tumors. If such a risk does exist, the matter would be of considerable public health importance, given the rapid increase worldwide in the use of these devices. METHODS: We examined the use of cellular telephones in a case-control study of intracranial tumors of the nervous system conducted between 1994 and 1998. We enrolled 782 patients through hospitals in Phoenix, Arizona; Boston; and Pittsburgh; 489 had histologically confirmed glioma, 197 had meningioma, and 96 had acoustic neuroma. The 799 controls were patients admitted to the same hospitals as the patients with brain tumors for a variety of nonmalignant conditions. RESULTS: As compared with never, or very rarely, having used a cellular telephone, the relative risks associated with a cumulative use of a cellular telephone for more than 100 hours were 0.9 for glioma (95 percent confidence interval, 0.5 to 1.6), 0.7 for meningioma (95 percent confidence interval, 0.3 to 1.7), 1.4 for acoustic neuroma (95 percent confidence interval, 0.6 to 3.5), and 1.0 for all types of tumors combined (95 percent confidence interval, 0.6 to 1.5). There was no evidence that the risks were higher among persons who used cellular telephones for 60 or more minutes per day or regularly for five or more years. Tumors did not occur disproportionately often on the side of head on which the telephone was typically used. CONCLUSIONS: These data do not support the hypothesis that the recent use of hand-held cellular telephones causes brain tumors, but they are not sufficient to evaluate the risks among long-term, heavy users and for potentially long induction periods.

Adult↗

PubMed1989

Medical advice by telephone at Swedish health centres: who calls and what are the problems?

Advice by telephone is an important activity at Swedish health centres and is mainly dealt with by nurses. This telephone counselling was studied during one week (Monday to Friday) at six Swedish health centres which were representative of rural as well as of urban populations. Based on the figures obtained from this study it could be calculated that about 20 million calls of this type are dealt with at Swedish health centres each year (population of Sweden about eight million). It was more common for women than for men to contact the health centre by telephone. About 70% of the calls were made by the patients themselves. Pain was the most common reason for contacting the health centre by telephone, followed by signs of infection. The majority of the telephone calls dealt with sick care, a minority were classified as administrative. About 40% of all calls were managed by the telephone adviser without involving the doctor at the health centre. Of all incoming calls, 44% resulted in an appointment time for a visit to a physician at the health centre, more than half of these being given for a visit during the same day. As the telephone counsel function is an important part of the activity at a Swedish health centre, it is important to evaluate its content and consequences.

Community Health Centers↗

PubMed1996

Overall mortality of cellular telephone customers.

Unlike mobile cellular telephones, in which the antenna is not part of the handset, a portable cellular telephone exposes the user's head to radio frequency energy transmitted from the antenna. This exposure has prompted concerns about potential biological effects, including brain cancer. As a first step in a record-based mortality surveillance of cellular telephone customers, we report on overall mortality of a cohort of more than 250,000 portable and mobile telephone customers during 1994. We found age-specific rates to be similar for users of the two types of telephones. For customers with accounts at least 3 years old, the ratio of mortality rates in 1994 for portable telephone users, compared with mobile telephone users, was 0.86 (90% confidence interval = 0.47-1.53).

Adult↗

PubMedDate not supplied

Telephone listening ability for hearing-impaired individuals.

Forty-five subjects with bilateral sensorineural hearing losses were divided into three groups (N = 15/group) based on the audiometric configuration of their test ear. The subjects were evaluated in three listening conditions by assessing their word discrimination ability by presenting stimuli at 86 dB SPL (simulating the output of a standard telephone handset ) and most comfortable loudness (MCL) (simulating the output of a telephone amplifier handset ). The three listening conditions were TDH-39 earphone, unaided telephone, and aided telephone with their personal hearing aid acoustically coupled to a telephone handset . Results indicated that subjects with precipitous hearing losses had similar word discrimination scores for all three listening conditions at 86 dB SPL and MCL. Subjects with gradual slope or flat hearing losses had similar word discrimination scores with a TDH-39 earphone, unaided telephone, and their hearing aids acoustically coupled to a telephone handset at 86 dB SPL. The subjects with gradual slope or flat losses also had similar word discrimination scores across the listening modes at MCL, but they had better word discrimination scores in all listening modes when the word lists were presented at MCL compared with 86 dB SPL.

Hearing Aids↗

PubMed1994

Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey.

Many health status surveys have been designed for mail, telephone, or in-person administration. However, with rare exception, investigators have not studied the effect the survey mode of administration has on the way respondents assess their health and other important parameters (such as response rates, nonresponse bias, and data quality), which can affect the generalizability of results. Using a national sampling frame of noninstitutionalized adults from the General Social Survey, we randomly assigned adults to a mail survey (80%) or a computer-assisted telephone survey (20%). The surveys were designed to provide national norms for the SF-36 Health Survey. Total data collection costs per case for the telephone survey ($47.86) were 77% higher than that for the mail survey ($27.07). A significantly higher response rate was achieved among respondents randomly assigned to the mail (79.2%) than telephone survey (68.9%). Nonresponse bias was evident in both modes but, with the exception of age, was not differential between modes. The rate of missing responses was higher for mail than telephone respondents (1.59 vs. 0.49 missing items). Health ratings based on the SF-36 scales were less favorable, and reports of chronic conditions were more frequent, for mail than telephone respondents. Results are discussed in light of the trade-offs involved in choosing a survey methodology for health status assessment applications. Norms for mail and telephone versions of the SF-36 survey are provided for use in interpreting individual and group scores.

Adult↗

PubMed1999

Teaching telephone management skills to pediatric residents in a pilot program using a standardized patient.

BACKGROUND: Pediatricians spend a significant amount of time on the telephone but receive little formal training in telephone management skills. We found only two previous reports in the literature using a randomized controlled trial (RCT) that documented the effectiveness of a telephone management program for residents. METHODS: The goals of this pilot study were (1) to provide second year pediatric residents (PL-2s) an experimental telephone management educational program, using a standardized patient (SP); (2) to assess the PL-2s' affective skills and ability to address relevant content on a series of simulated telephone calls; and (3) to determine whether feedback to the experimental group would improve their telephone management skills. RESULTS: In this small pilot RCT using an SP intervention, no improvement was found in PL-2s' short-term or long-term telephone management skills. CONCLUSION: Further studies involving larger number of residents and revised study design are needed in planning effective approaches to teaching these important skills to pediatric residents in our training program.

Data Collection↗

PubMed2001

Use of the telephone in prelingually deaf children with a multichannel cochlear implant.

OBJECTIVE: To assess progress in the use of the telephone in a group of prelingually deaf children after cochlear implantation. SETTING: Tertiary referral pediatric cochlear implant center in the U. K. STUDY DESIGN: A prospective study was undertaken on a consecutive group of 150 congenital and prelingually deaf children up to 5 years after implantation. The study group was confined to prelingually deaf children aged less than 7 years at the time of implantation. No child was lost to follow-up, and there were no exclusions from the study. At the time of the study, 129 children had reached the 1-year stage, and 91, 68, 40, and 23 had reached the 2-, 3-, 4-, and 5-year intervals, respectively. METHODS: A specifically designed profile was used to assess the telephone use of the implanted children. Regression analysis was used to assess the correlation between the results of the telephone profile with the outcomes of the Iowa sentence test and connected discourse tracking. RESULTS: After implantation, prelingually deaf children showed significant progress in telephone use over time, not reaching a plateau at the 5-year interval (median score 27 with maximum score available 34). The results of the telephone profile showed significant correlations with the other tests of speech perception (correlation coefficients from 0.47 to 0.79, all statistically significant p < 0.0001). CONCLUSION: The telephone profile provided a useful method of monitoring children's telephone use. The profile was easily administered, and it was sensitive in assessing the progress of prelingually deaf children with cochlear implants. Outcomes from the profile were highly correlated with results from other widely used closed- and open-set tests.

Child↗

PubMed2006

Characteristics of telephone calls in a psychiatric outpatient practice.

OBJECTIVE: The goal of this study was to document the volume and characteristics of telephone calls from patients in an outpatient psychiatric clinic. METHODS: Telephone calls from a psychiatric resident's patients were logged over a 6-month period. Information collected included sex of the caller, reason for the call, deemed importance of the call, primary psychiatric diagnosis, and insurance type. RESULTS: A total of 291 calls occurred during the 6-month period, with an average of 2.4 calls per work day. The physician deemed 1.5% of calls to be an emergency and 15% to be urgent. Of the resident's total case load of 115 patients over the 6 month period, 29% (n = 33) of patients never made physician-patient telephone contact. Female patients were significantly more likely to call than males. Requests for medication refills were the most frequent type of call (38%). The mean number of calls per patient in the caseload was significantly different across diagnostic groups, with patients with personality disorders and anxiety spectrum disorders making more calls than other groups. There was no significant difference in the volume of telephone calls between patients with private health insurance and those without. CONCLUSION: This study may be of particular interest to physicians and managed care systems who are interested in reimbursement for telephone psychiatry. This study confirms and extends the previously reported association between certain psychiatric disorders (personality disorders, anxiety spectrum disorders) and relative frequency of telephone calls to the physician. In addition, the high volume of calls for prescription refills is an important issue in telephone management.

Emergencies↗

PubMed2007

Preclinic appointment telephone contact: an effective intervention for colposcopy clinic nonattendance.

OBJECTIVE: To assess the impact of preclinic appointment telephone contact with prospective patients on colposcopic clinic default rates. MATERIALS AND METHODS: All women attending the Cornwall Colposcopy Service in Truro, UK, between July and October 2003, were recruited and randomly assigned into two groups. The patients in one group (group A) were contacted by telephone 12 to 24 hours before their clinic appointments to be reminded of their appointments. Confirmation of their attendance was obtained. For patients who indicated their inability to attend, a new date and time was offered. The patients in the other group (group B) were not contacted by telephone. RESULTS: Ninety-one percent of patients randomized to group A attended their clinic appointment compared with 69% of patients in group B (who had no preclinic appointment telephone contact) (chi1=15.74; p=00073). The odds ratio was 4.68 (95% CI=2.8-10.45), thus implying that patients who were contacted by telephone before their clinic appointment are about five times more likely to attend compared with their counterparts who were not contacted by telephone. CONCLUSIONS: Our study shows that preclinic appointment telephone contact of prospective patients attending colposcopy clinic was an effective intervention to reduce clinic nonattendance.

Adult↗