Commentary on Pascoe SW and Neal RD (2004) Primary care: questionnaire survey of alternative forms of patient and nurse face‐to‐face consultations. Journal of Clinical Nursing 13, 406–407

Abstract

This paper reports, in brief, on a study that surveyed general practice patients and practice nurses about using the telephone or email as alternatives to face-to-face consultations with the nurse. The goal of this study was to investigate ways of improving access for patients to practice nurse appointments. Similarly, other authors have reported studies about the use of ‘telehealth’, ‘telemedicine’, ‘telenursing’ or ‘advice nursing’ as means to improving access to limited, inaccessible or overstretched health services; containing health service costs; referral to appropriate level of service and/or improving continuity of care between hospital and community (e.g. Lattimer et al. 1998, Foster et al. 1999, Hagan et al. 2000, Turner et al. 2002, Omery 2003, Valanis et al. 2003). Telehealth, the provision of health services via telecommunication technologies, has been initiated in many countries, in a variety of settings, and by a range of providers. In the UK, NHS Direct is a 24-hour government-funded telephone advice line staffed by nurses to recommend home care or referral to appropriate health care services. Australia adopted a version of this for the state of Western Australia called Health Direct. In the US there are many commercial telephone call centres and most hospitals have some form of telephone triage system. Some services are available to the whole population of the area serviced while others are specific to defined population groups such as the mentally ill, those with HIV/AIDS, recently discharged surgical patients or carers of young children. In response to this growing trend in health care, researchers have been keen to investigate such issues as cost effectiveness, client and provider satisfaction, appropriateness of advice or referral, health outcomes and clinical decision-making processes. Concentrating specifically on the role of nurses in this mode of health care, Omery (2003) conducted a systematic review of Advice Nursing. Full text reviews were undertaken on 62 studies. The most frequently investigated subject was delivery/continuity of care in relation to chronic disease and/ or symptom management care needs. All the studies concluded that advice nursing provided a valuable service and, had it not been available, the patient would not have received care or would have taken up clinic time, urgent care appointments, or emergency department resources. The most common reason for calling a nurse advice line was found to be self-care advice for a range of minor problems including administration of drugs and identification of their sideeffects; wound management and care of dressings; musculoskeletal problems; symptom management for chronic illness; or care for cold or flu symptoms. Patients usually reported over 80% satisfaction with the service provided. In the light of these findings it is interesting that Pascoe and Neal found almost no support for the use of phone or email as an alternative to face-to-face consulting in their general practice study setting. Their primary explanation of their study results is the perceived necessity of the physical presence of the patient to undertake an assessment and/or provide therapeutic intervention. Because of the nature of a ‘Research in Brief’ paper the reader has very little detail of the sample characteristics other than being aged over 16 years and having a booked appointment with the practice nurse. It would be informative to know the reason for consultation and whether the booking was patient or practice initiated. It may be the case that most of these patients were booked for ongoing wound care or physical assessment and that the usual practice is for the nurse or general practitioner to undertake these procedures. Therefore the patients, and possibly the nurses, may perceive that any alternative to this arrangement (especially self-care advice) is ‘second rate’ health care. Many publications relating to the acceptance and success of telenursing services stress the importance of the use of guidelines and/or protocols to diagnose, advise or refer patients and additional training for nurses in these procedures. In addition, education of the public as to the availability and purpose of the service is essential. It is not Correspondence: Elizabeth Patterson, Senior Lecturer and Deputy Head, School of Nursing, Griffith University-Gold Coast, PMB 50, GCMC Australia 9726. E-mail: e.patterson@mailbox.gu.edu.au