Abstract
OBJECTIVES: To document the outcomes of a telephone coverage system and identify patient characteristics that may predict these outcomes.
DESIGN: Telephone survey.
SETTING: An academic outpatient medical practice that has a physician telephone coverage service.
PATIENTS: All patients (483) who called during the 3-week study period to speak to a physician were evaluated, and for the 180 patients with symptoms, attempts were made to survey them by telephone 1 week after their initial telephone call.
MEASUREMENTS AND MAIN RESULTS: The mean age of the 180 patients was 41 years, 71% were female, and 56% belonged to commercial managed care plans. In the week after the initial telephone call, the following outcomes were reported: 27% of the patients had no further contact with the practice; 9% filled a prescription medication; 19% called the practice again; 48% kept an earlier appointment in the practice; 3% saw an internist elsewhere; 8% saw a specialist; 8% went to an emergency department; 4% were admitted to a hospital. Of the 180 patients who called with symptoms, 160 (89%) were successfully contacted for survey. Eighty-seven percent of these 160 patients rated their satisfaction with the care they received over the telephone as excellent, very good, or good. In multivariate analysis, patients’ own health perception identified those most likely to have symptom relief (p=.002), and symptom relief, in turn, was a strong predictor of high patient satisfaction (p=.006). Thirty-three percent of the 160 patients reported that they would have gone to an emergency department if a physician were not available by telephone.
CONCLUSIONS: In the present study, younger patients, female patients, and patients in commercial managed care plans used the telephone most frequently. Also, the telephone provided a viable alternative to emergency department and walk-in visits. Overall satisfaction with telephone medicine was high, and the strongest predictors of high patient satisfaction were symptom relief and patients’ own health perception.
Similar content being viewed by others
References
Radecki SE, Neville RE, Girard RA. Telephone patient management by primary care physicians. Med Care. 1989;27:817–22.
Morrison RE, Arheart KL, Rimner W. Telephone medicine in a southern university private practice. Am J Med Sci. 1993;306:157–9.
Johnson BE, Johnson CA. Telephone medicine: a general internal medicine experience. J Gen Intern Med. 1990;5:234–9.
Peters RM. After-hours telephone calls to general and subspecialty internists: an observational study. J Gen Intern Med. 1994;9:554–7.
Greenhouse DL, Probst JC. After-hours telephone calls in a family practice residency: volume, seriousness, and patient satisfaction. Fam Med. 1995;27(8):525–30.
Wasson J, Gaudette C, Whaley F, Sauvigne A, Baribeau P, Welch HG. Telephone care as a substitute for routine clinic follow-up. JAMA. 1992;267:1788–93.
Daugird AJ, Spencer DC. Characteristics of patients who highly utilize telephone medical care in a private practice. J Fam Pract. 1989;29:59–64.
Bertera EM, Bertera RL. The cost-effectiveness of telephone vs. clinic counseling for hypertensive patients: a pilot study. Am J Public Health. 1981;71(6):626–9.
Nagle JP, McMahon K, Barbour M, Allen D. Evaluation of the use and usefulness of telephone consultations in one general practice. Br J Gen Pract. 1992;42:190–3.
Dale J, Crouch R, Patel A, Williams S. Patients telephoning A&E for advice: a comparison of expectations and outcomes. J Accid Emerg Med. 1997;14:21–3.
Sorum PC. Compensating physicians for telephone calls. JAMA. 1994;272:1949–50.
Braithwaite SS, Unferth NO. Phone fees: a justification of physician charges. J Clin Ethics. 1993;4(3):219–24.
Isaacman DJ. Telephone fees: are they worth it? J Clin Ethics. 1993;4(3):271–2.
Studdiford JS, Panitch KN, Snyderman DA, Pharr ME. The telephone in primary care. Prim Care. 1996;23(1):83–102.
Fishbein M, Azjen I. Belief, Attitude, Intention and Behavior. Don Mills, NY: Addison-Wesley; 1975.
Flannery MT, Moses GA, Cykert S, et al. Telephone management training in internal medicine residencies: a national survey of program directors. Acad Med. 1995;70:1138–41.
Zylke JW. Physicians need better line on how, when to respond to patients via telephone. JAMA. 1990;264:1797–8.
Hannis MD, Hazard RL, Rothschild M, Elnicki DM, Keyserling TC, DeVellis RF, TELI group. Physician attitudes regarding telephone medicine. J Gen Intern Med. 1996;11:678–83.
Elnicki DM, Hannis M, Flannery M, TELI group. The inadequate preparation of residents for telephone interactions with ambulatory patients. J Gen Intern Med. 1994;9(suppl 2):74. Abstract.
Hannis MD, Elnicki DM, Morris DK, Flannery MT, TELI group. Can you hold please? How internal medicine residents deal with patient telephone calls. Am J Med Sci. 1994;308(6):349–52.
Fleming MF, Skochelak SE, Curtis P, Evens S. Evaluating the effectiveness of a telephone medicine curriculum. Med Care. 1988;26(2):211–6.
Elnicki DM, Keyserling TC, Devallis RF, et al. Issues affecting residents’ attitudes about telephone medicine for ambulatory patients. Teach Learn Med. 1996;8(3):142–7.
Cykert S, Flannery MT, Huber EC, et al. Telephone medical care administered by internal medicine residents: concerns of program directors and implications for residency training. Am J Med Sci. 1997;314(3):198–202.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Delichatsios, H., Callahan, M. & Charlson, M. Outcomes of telephone medical care. J GEN INTERN MED 13, 579–585 (1998). https://doi.org/10.1046/j.1525-1497.1998.00179.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1998.00179.x