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Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

Richards, D.A., Godfrey, L., Richardson, G., Russell, D., Meakins, J., Tawfik, J. and Dutton, E. (2002) Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs. British medical journal. pp. 1214-1217. ISSN 0959-535X

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Abstract

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments.

Item Type: Article
Copyright, Publisher and Additional Information: © 2002 BMJ Publishing Group Ltd
Keywords: RANDOMIZED CONTROLLED TRIAL, PRIMARY-CARE, CONSULTATION
Institution: The University of York
Academic Units: The University of York > Economics and Related Studies (York)
The University of York > Centre for Health Economics (York)
Depositing User: Repository Officer
Date Deposited: 19 Jan 2006
Last Modified: 16 Oct 2014 11:39
Published Version: http://dx.doi.org/10.1136/bmj.325.7374.1214
Status: Published
Refereed: Yes
Related URLs:
URI: http://eprints.whiterose.ac.uk/id/eprint/125

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