Telephone Appointments Research Articles

Informed patients, reformed clinicians

Informed patients, reformed clinicians

Using conjoint analysis to assess depression treatment preferences among low-income Latinos.

The authors examined the feasibility of conjoint analysis for measuring the depression treatment preferences of low-income, low-literacy Latino primary care patients. Forty-two patients with depression (58 percent of those eligible for the study) completed a survey about preferences for treatment and strategies to reduce barriers to care. They preferred combined counseling and medication to either approach alone and preferred individual over group treatment but did not show a significant preference for treatment setting. The odds of treatment acceptance were increased by the availability of telephone appointments, bus passes, and help with making appointments. Although further validation is required, conjoint analysis appears to be feasible for assessing preferences regarding depression treatment in this underserved population.

A case report: implementing a nurse telecare program for treating depression in primary care.

The treatment of depression in primary care needs improvement. Previously, we reported that a nurse telecare intervention for treating depression in primary care clinics significantly improved treatment outcomes. The usefulness of nurse telecare, however, depends upon the feasibility of dissemination. In this report we describe nurse telecare and the steps required for implementation, and describe its dissemination in various settings. In addition to medication, which is managed by a primary care physician, the key elements of nurse telecare are focused behavioral activation, emotional support, patient education, promotion of treatment adherence, and monitoring of progress, delivered in ten brief telephone appointments over four months by primary care nurses. Support from key administrators and clinical champions is crucial to success. Nurses need "dedicated" scheduled time for telecare activities. Nurse telecare has been piloted and disseminated in diverse settings. The model required only small modifications for dissemination, and was implemented with minimal investment of resources and no negative impact on clinic operations.

TELEPHONE COGNITIVE BEHAVIOUR THERAPY FOR CHRONIC FATIGUE SYNDROME IN SECONDARY CARE: A CASE SERIES

Four randomized controlled trials have shown out-patient cognitive behaviour therapy reduces fatigue and disability in people suffering from chronic fatigue syndrome (CFS). However, some patients referred to Kings College Hospital, London are unable to attend regular appointments. We therefore developed a self-help treatment manual using cognitive-behavioural principles for patients to use at home with telephone contact with a therapist. Nine consecutive patients with a diagnosis of CFS who were unable to attend regular out-patient appointments used this self-help treatment approach at home. The therapist (MB) carried out a face-to-face assessment at the hospital. Subsequently, patients had fortnightly telephone appointments to discuss their progress, plan and discuss their homework and any problems. Outcome was evaluated using measures of functional impairment, fatigue, mood and general health before and after treatment and at 3 and 6-month follow-up. Eight patients completed treatment. Functional impairment, fatigue and general health improved at discharge and gains were maintained at 6-month follow-up. Self-treatment at home guided by a manual with fortnightly telephone sessions was helpful in the treatment of patients with chronic fatigue syndrome. A randomized controlled trial is underway to compare telephone cognitive behaviour therapy with out-patient cognitive behaviour therapy. Patients with other conditions such as chronic pain who are unable to travel for regular appointments may benefit from a home-based treatment package involving therapist contact by phone.

An Evaluation of Initial Non-attendance Rates for Physiotherapy

Summary Non-attendance for physiotherapy appointments is, as elsewhere in the health service, a costly problem. This study, based in a physiotherapy department of a District general hospital, monitored non-attendance for initial appointments over seven months, aiming to identify common trends in failure to attend and evaluate the effects of different methods of contact used to make the initial appointments. Details of age and sex, plus source of referral, diagnosis and time spent on the waiting list were noted for each non-attender. Appointments were made in one of three ways — by post, by post with information leaflet included with the appointment card, and by telephone. Results showed that more males than females were likely to fail to attend as were referrals from general practitioner sources compared to consultant; 58% of all non-attenders were 21 to 50 years old. Telephone appointments produced a 4.7% non-attendance rate compared to 8.9% of those appointments made by post.

Interventions to Reduce Missed Telephone Appointments at an Employee Assistance Program

ABSTRACT This study investigated two interventions delivered during an intake procedure to 60 female and 15 male employee clients seeking telephone counseling in the employee assistance program (EAP) of a large diversified financial corporation. Clients receiving the “direct request” intervention were asked to keep their appointments out of courtesy to their counselors; clients receiving the “brief solution-focused” intervention were asked to reflect on their current coping strategies and informed that their counselors would be interested in hearing about these strategies. The effect of these two interventions on client no-show rates and counselor satisfaction ratings, as reported by 5 female and 2 male counselors, was examined. No significant differences were found between treatment and control groups. In addition, the waiting time before client appointments was found to have no significant effects on no-show rates. These results conflict to some extent with earlier research findings, and may reflect dif...

1428 Nurse's outpatient telephone appointments at a regional hospital's day-care ward for patients undergoing cytotoxic therapy

Cytotoxic therapy is given mainly on the day-care ward. The patients receive extensive instruction before treatment. Usually they visit the day-care ward only for intravenous cytotoxk therapy. The nursing staff attaches much value to contact with patients in between treatments for advice and support. Deterioration of their general condition should be recognized early. Hofpoort is a regional hospital. Visits on the day-care ward imply a lot oftime, energy and stress. As part of a quality assurance program routine telephone contacts in between treatments were initiated if the interval exceeded one week. The patients are informed about the aim of the contacts and if they agree, the contact is scheduled. During the conversation the situation of the previous week is assessed and adequate advice can be given. If necessary the patient is referred to his/her physician, a dietician or a social worker. A well kept patient report is maintained. This setup has proven to be feasible and effective. Patients are able to get answers to important questions and many problems can be prevented. The level of care for patients on the daycare ward is improved and relations between nurses and patients are optimized. Cytotoxic therapy is given mainly on the day-care ward. The patients receive extensive instruction before treatment. Usually they visit the day-care ward only for intravenous cytotoxk therapy. The nursing staff attaches much value to contact with patients in between treatments for advice and support. Deterioration of their general condition should be recognized early. Hofpoort is a regional hospital. Visits on the day-care ward imply a lot oftime, energy and stress. As part of a quality assurance program routine telephone contacts in between treatments were initiated if the interval exceeded one week. The patients are informed about the aim of the contacts and if they agree, the contact is scheduled. During the conversation the situation of the previous week is assessed and adequate advice can be given. If necessary the patient is referred to his/her physician, a dietician or a social worker. A well kept patient report is maintained. This setup has proven to be feasible and effective. Patients are able to get answers to important questions and many problems can be prevented. The level of care for patients on the daycare ward is improved and relations between nurses and patients are optimized.

Feminist Art Theory in Atlanta

Two women's voices are woven into this article, the assessment of a survey made in Atlanta in the winter of 1989–90. The voice of the statistician, who made judgments concerning the language and numerical significance of the survey, is trained to be objective. The voice of the artist (the “I”) is motivated, speculative, and muddied by the effort of turning over stones in someone else's garden. I made countless telephone calls, appointments, and requests to administer the survey questionnaire. My story is colored by tones of voice and facial expressions encountered during this process that cannot be extracted from numerical results.

Utilizing the Phone Appointment for Adolescent Follow-up

Fifty young women were given 126 telephone appointments as a supplement to follow-up care in a university hospital adolescent clinic. Eighty (64%) calls were placed on the appropriate day, 71 (89%) of which were within 20 minutes of the assigned time. Patients with one or two clinic visits honored 39 of 52 (75%) of their phone appointments, whereas those with 11 or more visits kept only 8 of 17 (47%). Telephone appointments scheduled directly in the clinic were kept on 66 of 98 (67%) occasions as compared to 14 of 28 (50%) for those made over the phone. Sixty-four of 93 (69%) calls were made when the interval from the time the phone appointments were given to date of appointment was 7 days or less, while 16 of 33 (48%) responded when this period was 8 days or longer. The data document the compliance of adolescent girls with telephone appointments and suggest that this technique may be a useful adjunct for monitoring patients requiring close medical follow-up.

Use of the Telephone for Short-Term Follow-Up

We have instituted a telephone appointment system (TAS) to follow patients with well-defined relatively minor problems. The patient is asked to call a special phone number at a specified date and time to obtain test results or information. A senior physician reviews each chart beforehand and indicates in lay terms, the information to be given to the patient by the clerk. Initial contact was made with 235 (58%) of the 404 scheduled telephone appointments reviewed during a four-week period. Physician data review time averaged one minute per chart and two full-time clerks were required. Although no improvement in patient compliance was found, significant savings of patient, physician, and nursing time are obvious. Additional advantages include decreased total patient load and the opportunity for senior physicians to assess the quality of care and provide feedback to the emergency department house officers.

The Effect of Prior Telephone Appointments on Completion Rates and Response Content

As Stephan and McCarthy indicate, research is needed on the effectiveness of various methods in increasing the completion rate in fixed-address surveys.' One such method they note as being worthy of research is the usel of prior telephone calls to selected respondents. The suggestion is that by calling units beforehand and arranging an interview it may be possible to increase the completion rate by reducing the not-at-home rate. At the same time, however, such a procedure may increase the refusal rate since individuals might find it easier to refuse an interviewer over the phone than in person. Additionally, of course, even if those chosen agree to the interview, they still can refuse to cooperate at the time of appointment. Regardless of the effect of the telephone call on the completion rate, the researcher must also be concerned about the effect of the prior knowledge upon the content of the sampled units' responses. The experiments described in this report were primarily directed toward assessing the effect of a prior telephone call on the interview completion rate, although response pattern differences were also studied.