Telephone Advice Research Articles

Infectious diseases in early education and child care programs.

1. Timothy R. Shope, MD, MPH* 1. *Department of Pediatrics, Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA. * Abbreviations: AAP: : American Academy of Pediatrics CFOC3: : Caring for Our Children , 3rd ed ECE: : early care and education RSV: : respiratory syncytial virus Out-of-home care and education are the norms for most young children and lead to increased exposure to infectious diseases. Pediatricians need to be aware of strategies to reduce the risk of infection and guidelines for determining exclusion and return to care for mildly ill children who participate in group care arrangements. After completing this article, readers should be able to: 1. Recognize the risks of infectious diseases in children who participate in early care and education programs. 2. Understand methods for reducing infectious diseases in early care and education settings. 3. Identify which infectious diseases require exclusion from early care and education programs. Two-thirds of children younger than 6 years participate in nonparental out-of-home early education and child care. Demographic trends during the past several decades reflect an increased desire and need to work for men and women who are parents. During the first 2 years of participation, children enrolled in early care and education (ECE) programs experience a higher incidence of respiratory and diarrheal infections, otitis media, and antibiotic-resistant bacteria compared with their peers primarily cared for at home. The types of infection generally reflect common respiratory and gastrointestinal viruses in circulation in the community. However, there are some infectious diseases that can cause outbreaks or clusters of infections in ECE settings. When ill children are excluded from an ECE facility, parents may miss work, lose income, and seek health care services in an effort to return their children to child care. Pediatricians need to be aware of the infectious disease risks of child care attendance and various strategies for reducing them. In addition, pediatricians need to be knowledgeable about rational exclusion and return …

G371(P) “Review of the telephone advice provided by a tertiary nephrology centre to the surrounding region”

BackgroundThe 2011 BAPN Publication “Improving the standard of care of children with kidney disease through paediatric nephrology networks” focuses on making the patient a priority. Key recommendations include facilitating the...

152. The Hidden Toil of the Rheumatology Department: Evaluating the Work of the Rheumatology Telephone Advice Lines in East Anglia

152. The Hidden Toil of the Rheumatology Department: Evaluating the Work of the Rheumatology Telephone Advice Lines in East Anglia

AN EDUCATIONAL TOOLKIT: SPECIALIST PALLIATIVE CARE TELEPHONE ADVICE LINE

BackgroundAudit has shown that Integrated Specialist Palliative Care Telephone Advice Lines provide expert support to healthcare professionals caring for patients with palliative and end of life care needs. Governance arrangements...

PALLIATIVE CARE IN THE YOUNG PERSON'S COMMUNITY: SUPPORT FOR SCHOOLS

IntroductionBeing part of a school community, where young people develop peer relationships and experience a sense of their value in society, is integral to childhood/young adulthood. Supporting terminally ill young...

AUDIT OF A SPECIALIST PALLIATIVE CARE TRIAGE ADVICE LINE WITHIN SOUTH TEES

BackgroundSouth Tees Community Specialist Palliative Care Team (SPCT) provides Specialist Palliative Care support to a diverse population across the Middlesbrough and Redcar/Cleveland areas. Data collection in recent years has shown...

Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions: study protocol for two linked randomized controlled trials

BackgroundAs the population ages, more people are suffering from long-term health conditions (LTCs). Health services around the world are exploring new ways of supporting people with LTCs and there is great interest in the use of telehealth: technologies such as the Internet, telephone and home self-monitoring.Methods/DesignThis study aims to evaluate the effectiveness and cost-effectiveness of a telehealth intervention delivered by NHS Direct to support patients with LTCs. Two randomized controlled trials will be conducted in parallel, recruiting patients with two exemplar LTCs: depression or raised cardiovascular disease (CVD) risk. A total of 1,200 patients will be recruited from approximately 42 general practices near Bristol, Sheffield and Southampton, UK. Participants will be randomly allocated to either usual care (control group) or usual care plus the NHS Direct Healthlines Service (intervention group). The intervention is based on a conceptual model incorporating promotion of self-management, optimisation of treatment, coordination of care and engagement of patients and general practitioners. Participants will be provided with tailored help, combining telephone advice from health information advisors with support to use a range of online resources. Participants will access the service for 12 months. Outcomes will be collected at baseline, four, eight and 12 months for the depression trial and baseline, six and 12 months for the CVD risk trial. The primary outcome will be the proportion of patients responding to treatment, defined in the depression trial as a PHQ-9 score <10 and an absolute reduction in PHQ-9 ≥5 after 4 months, and in the CVD risk trial as maintenance or reduction of 10-year CVD risk after 12 months. The study will also assess whether the intervention is cost-effective from the perspective of the NHS and personal social services. An embedded qualitative interview study will explore healthcare professionals’ and patients’ views of the intervention.DiscussionThis study evaluates a complex telehealth intervention which combines evidence-based components and is delivered by an established healthcare organisation. The study will also analyse health economic information. In doing so, the study hopes to address some of the limitations of previous research by demonstrating the effectiveness and cost-effectiveness of a real world telehealth intervention.Trial registrationCurrent Controlled Trials: Depression trial ISRCTN14172341 and cardiovascular disease risk trial ISRCTN27508731.

A randomized controlled trial of a video module to increase U.S. poison center use by low-income parents

Context. U.S. poison centers decrease medical visits by providing telephone advice for home management of potential poisonings, but are underutilized by low-income African-American and Latino parents, and those with limited English proficiency, due to lack of knowledge and misconceptions about poison centers. Objectives. To assess the effectiveness of a poison prevention video module in improving knowledge, behavior, and behavioral intention concerning use of poison centers in a population of low-income, language-diverse adults attending parenting courses offered by a community organization. Methods. A randomized, blinded, controlled trial was conducted at 16 parenting course sites of a community organization and included 297 participants. The organization's instructors presented the video module (intervention) or the usual class curriculum (control). Participants completed questionnaires at baseline and a telephone interview 2–4 weeks later. Changes from baseline to follow-up were compared between the intervention and control groups using analysis of variance and Chi-square tests. Intervention group participants were stratified by English proficiency and compared to assess baseline and follow-up responses by language. Results. After the intervention, participants in the intervention group had a significantly greater increase in knowledge about the poison center, were more likely to have the correct poison center phone number at home, and had greater behavioral intention to use the poison center compared to control group participants. At baseline, Spanish-primary-language participants with limited English proficiency had less knowledge about the poison center, were less likely to have the poison center number at home, and had lower behavioral intention to use the poison center than English proficient participants, but significantly improved after the intervention. Conclusions. This video module, when presented by a community organization's instructors, was highly effective in improving knowledge, behavior, and behavioral intention concerning use of poison centers within a low-income, language-diverse population.

British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013

British <scp>HIV A</scp>ssociation guidelines for the management of hepatitis viruses in adults infected with <scp>HIV</scp> 2013

Geographical barriers to education law advice: access, communications and public legal services in England and Wales

In line with changes to the delivery of other public services, current reforms to publicly funded legal advice services within England and Wales seek to move services from traditional face‐to‐face settings to delivery predominantly over the telephone. Government justification for the policy has focused on greater equality of access. In contrast, criticisms have centred upon the inability of the telephone to address the needs of certain client groups or complex cases. Using administrative records collected by the Legal Services Commission on the use of education law advice services, this paper considers the extent to which telephone services overcome barriers caused by distance from advice sources, as well as their ability to deliver comparable service and achieve similar outcomes to face‐to‐face services. Clear evidence emerged that as distance increased between service users and their closest provider, so did the likelihood of using telephone advice. However, when looking at the nature of the service received and the outcome achieved for clients, there were notable differences, with face‐to‐face service users far more likely to achieve tangible outcomes. Few telephone cases moved beyond the initial stages of advice. Telephone services did mediate the impact of distance, although there were concerns over the comparability of the service delivered by the two modes. Despite this, the paper highlights the importance of going beyond simply measuring access in terms of utilisation alone, also measuring it in terms of the outcomes achieved.

A pragmatic randomised controlled trial of ‘PhysioDirect’ telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation

ObjectivesTo compare the cost-effectiveness of PhysioDirect with usual physiotherapy care for patients with musculoskeletal problems.Design(1) Cost-consequences comparing cost to the National Health Service (NHS), to patients, and the value of...

P13 Evening call

IntroductionThe End of Life Care (EoLC) Strategy (2008) and Preferred Priorities of Care (2011) documents support enabling people to remain in their own homes.Prompted by the volume of calls into...

P9 Is there anybody there - telephone advice lines who needs them?

Background and ContextNightingale House Hospice have offered a 24-hour telephone advice line to patients and their carers in North East Wales since the year 2000. Predominantly the area covered is...

Government money for telephone advice service as major provider quits

Government money for telephone advice service as major provider quits

Maintaining clinical governance when giving telephone advice

ObjectiveDelivering excellent healthcare depends on accurate communication between professionals who may be in different locations. Frequently, the first point of contact with the liver unit at King's College Hospital (KCH)...

P3.341 Sex and the London Olympics 2012 Part 1. Impact on Community Sexual Health Service Provision in London

BackgroundPredicting the impact on services is essential for managing large public events.ObjectivesTo measure the impact of the 2012 Olympics on service use in LondonMethodsData were gathered from London sexual health...

A physiotherapy telephone assessment and advice service for patients with musculoskeletal problems can improve the process of care while maintaining clinical effectiveness

Does a physiotherapy telephone assessment and advice service (PhysioDirect) affect physical health and improve the process of care in patients with musculoskeletal problems? Randomised controlled trial with concealed allocation and blinded outcome assessment. Four community physiotherapy services drawing patients from 94 general practices in England. Adults referred by a general practitioner or self-referred to physiotherapy for a musculoskeletal problem were eligible for inclusion. Referral from a consultant and an inability to communicate in English were key exclusion criteria. Randomisation of 2256 participants at a ratio of 2:1 allocated 1513 to PhysioDirect and 743 to the usual care physiotherapy. PhysioDirect participants were invited to telephone a physiotherapist for initial assessment and advice followed by further telephone advice and face-to-face physiotherapy if necessary. After the initial call most participants were sent written advice about self management and exercises. The usual-care comparison group joined a waiting list for face-to-face physiotherapy management. The primary outcome was change in physical health, measured with the physical component summary (PCS) measure from the SF-36 questionnaire at 6 weeks and 6 months. Secondary clinical outcome measures included the Measure Yourself Medical Outcomes Profile, global improvement in the main problem, and questions about satisfaction from the General Practice Assessment Questionnaire; and measures of process of care, including number of appointments, and waiting time. Primary outcome data were obtained from 85% of participants at 6 months. There was no difference in the SF-36 PCS measure between the PhysioDirect and comparison groups at 6 months (Mean difference (MD) = -0.01, 95% CI -0.80 to 0.79) and 6 weeks (MD 0.42, 95% CI -0.28 to 1.12). There were no differences between the groups in other clinical outcomes at 6 months, but there were small improvements in the PhysioDirect group at 6 weeks in the global improvement score (MD 0.15 units, 95% CI 0.02 to 0.28) and in the Measure Yourself Medical Outcomes Profile score (MD -0.19 units, 95%CI -0.30 to -0.07). 47% of PhysioDirect participants were managed entirely by telephone, and they had fewer face-to- face appointments (mean 1.9 vs 3.1), and a shorter wait for physiotherapy treatment (median 7 vs 34 days) than the comparison group. PhysioDirect participants were less satisfied with the service than the comparison group (MD -3.8%, 95% CI -7.3 to -0.3). Providing an initial telephone physiotherapy service for patients with musculoskeletal problems that reduced waiting time and required fewer appointments was as effective as providing face-to-face physiotherapy, but was associated with slightly lower patient satisfaction.

SAT0583-HPR Differences between Service Providers and Users when Defining Feasible Optimal NHs Occupational Therapy Treatment for Patients with Thumb Base OA: Results from a Delphi Study

BackgroundThe OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year developmental study for a full randomised controlled trial (RCT) into the clinical and cost effectiveness of an occupational therapy and splint...

PTH-178 Who Calls the Liver Registrar at King’S?

IntroductionDelivering excellent healthcare in today’s NHS involves multiple agencies and depends on accurate communication between professionals in different locations. King’s College Hospital is a leading Hepatology centre that receives tertiary...

Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial. Salisbury C, Montgomery AA, Hollinghurst S, et al. BMJ 2013;346:f43

Effectiveness of PhysioDirect telephone assessment and advice services for patients with musculoskeletal problems: pragmatic randomised controlled trial. Salisbury C, Montgomery AA, Hollinghurst S, et al. BMJ 2013;346:f43