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The effectiveness and cost effectiveness of telephone triage of

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The effectiveness and cost effectiveness of telephone triage of Powered By Docstoc
					                   Results!
       …..(and working with Clinical Research Organisations)


                    John Campbell

Professor of General Practice and Primary Care
 Peninsula College of Medicine and Dentistry
                    Exeter
   Inter-arm difference in BP
                       • Lancet 30 Jan 2012
                       • Systematic review and
                         meta-analysis – 28 studies
                       • Prevalence of sIAD >
                         15mmHg 12-15%
                       • sIAD > 15 mmHg 60%
                         increase all cause mortality
                         at 10 years
                       • sIAD > 15 mmHg 70%
Chris Clark              increase CV related
GP, PhD student PCMD     mortality at 10 years
Witheridge             • ITV; Daily Mail; NY times
Devon
Q      Research Question

For patients requesting same   day
appointments in general practice, how do:
   •Nurse-led computer-supported telephone triage
   •GP-led telephone triage
   •Usual care
compare in terms of their impact on the demand
for primary and secondary care, patient reported
well-being and satisfaction, safety, and costs?
Recruitment centres




            42 practices
            21,000 patients

GP triage    Nurse triage     Usual Care
Practice recruitment
                                  107 no response
            approached      342   114 declined
                                  16 ineligible
                                  12 may consider later
      expressed interest    93    16 declined
                                  5 ineligible
                                  11 in correspondence
              meetings      61
                                  12 declined
                                  4 ineligible
                agreed      45
                                  1 agreed as a reserve

           randomised       44
                                  2 withdrawn

                 in trial   42
Patient recruitment progress
25000




20000




15000
                                                                      Target


                                                                      Expected
10000


                                                                      Actual

 5000




    0




    -9,791 patients recruited (up to w/c 12th Dec)
    -Wave 1 Q response rate: 60% (3,584/5,994 Qs)
    -Wave 1 Rate of consent to Case Notes Review: 74% (4,604/6,199)
• Improving patient experience in Primary Care
• DH/NIHR funded 2009-2015
• Joint programmes with Cambridge
• John Campbell and Martin Roland joint developers of
  national GP patient survey
• Original link to pay for performance – now uncoupled
                       The Workpackages……..
Secondary analysis of GPPS                                Hard to reach
data                                                         groups




                       1&2
Reliability                                               Young adults
Casemix                                                    Probation
Disenrollment
QOF
Continuity
Trust and confidence
Dental
Out of hours
                                  3            Mystery shopper
                             Working with
                              practices
                                               Validating access
                             Credibility and       questions
                                reaction
                                   The projects……..
         Individual GP feedback                                      Analysis of communication
        Project 1                    Project 2                         Project 3                       Project 4
Practice understanding of      Differences between                 Patient ratings and           Patient responses to
    low survey scores           individual doctors                  actual behaviour               communication
                                  Individual GP                         Video                         Patient
    Focus groups
                                     survey                           recording                      interview

    Individual GP                 Individual GP                         Expert                       GP patient
      interview                     feedback                            raters                        survey




                Experience of South                                           Out-of-hours
                   Asian people                                             service provision
                             Project 5
                     Investigation of lower                                              Project 7
                             scores                   Project 6                    Out-of-hours care

                        Video ratings                                                 Survey &
                                                                                     interviews
                                                     Exploratory
                              Patient                                              GPPS & OPQ
                            interviews                  RCT
                                                                                     survey
   Validating the access questions
• ‘Mystery shopper’ study
• 41 practices recruited
   – 12 Devon
   – 8 Plymouth
   – 10 Torbay
   – 11 Cornwall & Isles of Scilly
• 410 calls to practices
• Requested prompt, non-urgent appointment
• Research disclosure 17 times ( <5%)
 Practice     Time to first   Time to third    Number of       Time to       Time to
              appointment     appointment      calls made     answer (s)   complete call
 access
                 (days)          (days)                                         (s)
   (N)
              Median (IQR)    Median (IQR)    Median (IQR)   Median (IQR) Median (IQR)

 High (19)        1(3)            2(4)            1(0)           4(7)         70(33)

Medium (11)       2(6)            3(7)            1(0)         7.5(17)       84.5(55)

 Low (11)        3.5(6)           5(7)            1(1)          8(11)        81.5(60)
                                                       NGPPS scores: the percentage of patients who ...

Mystery             ..find it easy to   ..can get an           ..can get an                                                     ..would
shopper             get through by      appointment           appointment         ..can see their   ..are satisfied with   recommend the
outcomes                phone           fairly quickly            ahead         preferred doctor*         the practice     practice to others

Median number           -0.34             -0.06                  0.04                -0.16                  -0.31               -0.09
of calls to get
through               (0.029)            (0.730)               (0.796)             (0.333)                (0.052)             (0.574)
Median time to          -0.10             -0.10                  0.08                -0.04                  -0.08               0.22
answer the phone
(s)                   (0.537)            (0.518)               (0.611)             (0.812)                (0.598)             (0.176)
Median time             -0.46             -0.39                  -0.42               -0.16                  -0.24               -0.46
taken to make
appointment (s)       (0.003)            (0.012)               (0.007)             (0.319)                (0.128)             (0.003)
Median wait for         -0.37             -0.69                  -0.09               -0.41                  -0.24               -0.17
3rd appointment
(d)                   (0.018)            (0.000)               (0.557)             (0.007)                (0.130)             (0.277)
Percentage of 1st       -0.37             -0.65                  -0.14               -0.49                  -0.24               -0.15
appointments not
within 2 days         (0.018)            (0.000)               (0.388)             (0.001)                (0.125)             (0.365)
* Results in this column are based on only those appointments where a specific doctor was requested.
The South West – a prime site for Quintiles research
Thanks for
your help!

				
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posted:7/1/2013
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