Telephone consultations to manage requests for same-day appointments: a randomised controlled trial in two practices

Abstract

This randomised controlled study aimed to investigate how the use of telephone consultations impacts on the management of requests for same-day appointments, on resource use, indicators of clinical care, and patient perceptions of consultations. The study lasted for four weeks and all patients seeking a same-day appointment in each surgery in two urban practices were recruited. The primary outcome measure was use of doctor time for the first telephone or face-to-face consultation. Secondary outcomes were subsequent use of investigations and of services in the two-week period following consultation, frequency of blood pressure measurement and antibiotic prescriptions, and number of problems considered at consultation. Patient perceptions were measured by the Patient Enablement Instrument (PEI) and reported willingness to use telephone consultations in the future. The study found that telephone consultations took less time. However, patients consulting by telephone reconsulted the GP more frequently in the two weeks that followed. Blood pressure was measured more often in the group of patients managed face-to-face but there was no significant difference in patient perceptions or secondary outcomes. The study concluded that the use of telephone consultations for same-day appointments was associated with time saving, and did not result in lower PEI scores. Possibly, however, this short-term saving was offset by higher re-consultation and less use of opportunistic health promotion.