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Our objective was to examine the construct validity of the Brief Test of Adult Cognition by Telephone (BTACT) and its relationship to traumatic brain injury (TBI) of differing severities. Data were analyzed on 1422 patients with TBI and 170 orthopedic trauma controls (OTC) from the multi-center Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Participants were assessed at 6 months post-injury with the BTACT and an in-person neuropsychological battery. We examined the BTACT's factor structure, factorial group invariance, convergent and discriminant validity, and relationship to TBI and TBI severity. Confirmatory factor analysis supported both a 1-factor model and a 2-factor model comprising correlated Episodic Memory and Executive Function (EF) factors. Both models demonstrated strict invariance across TBI severity and OTC groups. Correlations between BTACT and criterion measures suggested that the BTACT memory indices predominantly reflect verbal episodic memory, whereas the BTACT EF factor correlated with a diverse range of cognitive tests. Although the EF factor and other BTACT indices showed significant relationships with TBI and TBI severity, some group effect sizes were larger for more comprehensive in-person cognitive tests than the BTACT. The BTACT is a promising, brief, phone-based cognitive screening tool for patients with TBI. Although the BTACT's memory items appear to index verbal Episodic Memory, items that purport to assess EFs may reflect a broader array of cognitive domains. The sensitivity of the BTACT to TBI severity is lower than domain-specific neuropsychological measures, suggesting it should not be used as a substitute for comprehensive, in-person cognitive testing at 6 months post-TBI.

Background: A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent., Objective: This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices., Methods: This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study's patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status., Results: A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination., Conclusions: An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities in health care by underrepresenting the experience of certain groups in decision making based on the reach of different survey modes., (©Sharon Johnston, William Hogg, Sabrina T Wong, Fred Burge, Sandra Peterson. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.01.2021.)

Objective: In the current pandemic, tele-screening of neuropsychological status has become a necessity. Instruments developed for telephone screening are not as well validated as traditional neuropsychological measures. Therefore, the current study presents preliminary validation of a telephone version of the Montreal Cognitive Assessment (T-MoCA) in individuals with Parkinson's disease (PD). Method: Twenty-one persons with PD completed the T-MoCA along with a traditional neuropsychological battery. Diagnostic accuracy for the presence of PD-related mild cognitive impairment (MCI) and correlations with traditional neuropsychological measures are reported. Results: Individuals with MCI ( n  = 9) scored lower than individuals without cognitive impairment (17.56 vs. 19.50; t = -2.28, p = .03, d = -1.00). Diagnostic accuracy for MCI ranged from 76% to 81%, with sensitivity ranging from 0.56 to 0.67 and specificity ranging from 0.92 to 1.00. Correlations of T-MoCA derived scores with traditional neuropsychological measures were quite modest, with the exception of the memory impairment scale. Conclusions: This rapid communication presents preliminary validation of the T-MoCA for use in individuals with PD. Caveats and implications for practical use in the current pandemic are discussed.

Objective: Root cause analyses of serious adverse events (SAE) in out-of-hours primary care (OHS-PC) often point to errors in telephone triage. Such analyses are, however, hampered by hindsight bias. We assessed whether experts, blinded to the outcome, recognize (un)safety of triage of patients with chest discomfort, and we quantified inter-rater reliability., Study Design and Setting: This is a case-control study with triage recordings from 2013-2017 at OHS-PC. Cases were missed acute coronary syndromes (ACSs, considered as SAE). These cases were age- and gender-matched 1:8 with the controls, sampled from the remainder of people calling for chest discomfort. Fifteen experts listened to the recordings and rated the safety of triage. We calculated sensitivity and specificity of recognizing an ACS and the intraclass correlation., Results: In total, 135 calls (15 SAE, 120 matched controls) were relistened. The experts identified ACSs with a sensitivity of 0.86 (95% CI: 0.71-0.95) and a specificity of 0.51 (95% CI: 0.43-0.58). Cases were rated significantly more often as unsafe than the controls (73.3% vs. 22.5%, P < 0.001). The inter-rater reliability for safety was poor: ICC 0.16 (95% CI: 0.00-0.32)., Conclusions: Blinded experts rated calls of missed ACSs more often as unsafe than matched control calls, but with a low level of agreement among the experts., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Studies show that the primary reasons registered nurses (RNs) withdraw from registered nurse to bachelor of science in nursing (RN-BSN) programs are related to the challenge of sustaining work and family obligations while in school and having unclear expectations. It has been shown that nontraditional students facing these types of challenges benefit from programs that give strong sense of faculty connection and orient students to coursework by providing clear information., Purpose: The purpose of this project was to see if conducting one-on-one, script-guided orientation phone calls with individual students provided valuable programmatic information and established a sense of connection to faculty., Methods: Six RN-to-BSN faculty conducted a combined 108 orientation telephone calls to individual, newly enrolled online RN-to-BSN students. The purpose of the orientation was to introduce general program expectations required to successfully complete courses, and provide students with a sense of connectedness with faculty. Faculty developed and distributed a survey (3, 6-point Likert scale response items and 2 open-ended questions) to understand the degree to which RN-to-BSN students valued the orientation phone call., Results: Ninety-four percent (n = 101) of participating students agreed that the RN-BSN program orientation phone call resulted in feeling a "sense of connectedness" with the online program faculty member. Additionally, 95% (n = 102) agreed that the orientation phone call provided them with the necessary information to support success in their first course within an RN-BSN online program., Conclusion: One-on-one orientation telephone calls provided valuable program overview information and the personal conversational format conveyed to remote students faculty availability and an enhanced sense of connectedness., (© 2020 Wiley Periodicals LLC.)

To describe the design of a telephone follow-up protocol and to evaluate the feasibility of this protocol for advanced cancer pain patients. A series of nine telephone follow-up calls was implemented with 40 advanced cancer pain patients within 3 months after their discharge from the Department of Chemotherapy. Cancer pain information and the pain-related knowledge of the patients were collected by nurses using pain follow-up information sheets and the Patient Pain Questionnaire (PPQ); pain self-efficacy and the quality of life were reported by patients using the Chronic Pain Self-Efficacy Scale (CPSS) Chinese version and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC-QLQ-C30) Chinese version. The average score assessed by advanced cancer pain patients of the need for pain care from nurses was 24.28 (SD = 4.90). Twenty-one and eight patients completed all nine telephone follow-up calls and seven self-reported questionnaires, respectively. The pain intensity of patients at the time of follow-up was mild, but there had been breakthrough pain in the previous week. All patients were satisfied with the nurses' pain follow-up practices. There was a highly positive correlation between the time of follow-up and the patients' pain-related knowledge scores (r = 0.963**, p < 0.01). Patients' pain self-efficacy scores and quality of life scores varied across different dimensions. The baseline pain self-efficacy subscales were associated with all dimensions of quality of life (p < 0.05 or p < 0.01). Telephone follow-up can be an effective method of transitional care. For advanced cancer pain patients, it is still necessary to further explore the cost effectiveness of this method, including the appropriate follow-up duration, endpoints, and outcome measures based on government requirements and policies.

Introduction: While the EQ-5D-5L has been migrated to several electronic modes, evidence supporting the measurement equivalence of the original paper-based instrument to the electronic modes is limited., Objectives: This study was designed to comprehensively examine the equivalence of the paper and electronic modes (i.e., handheld, tablet, interactive voice response [IVR], and web)., Methods: As part of the foundational work for this study, the test-retest reliability of the paper-based, UK English format of the EQ-5D-5L was assessed using a single-group, single-visit, two-period, repeated-measures design. To compare paper and electronic modes, three independent samples were recruited into a three-period crossover study. Each participant was assigned to one of six groups to account for order effects. Descriptive statistics, mean differences (i.e., split-plot analysis of variance [ANOVA]), and intraclass correlation coefficients (ICCs) were calculated., Results: The test-retest results showed mean differences near zero and ICC values > 0.90 for both the index and the EQ VAS scores. For the electronic comparisons, mean difference confidence intervals (CIs) for the EQ-5D index scores and EQ VAS scores reflected equivalence of the means across all modes, as the CIs were wholly contained inside the equivalence interval. Further, the ICC 95% lower CIs for the index and EQ VAS scores showed values above the thresholds for denoting equivalence across all comparisons in each sample. No significant mode-by-order interactions were present in any ANOVA model., Conclusions: Overall, our comparisons of the paper, screen-based, and phone-based formats of the EQ-5D-5L provided substantial evidence to support the measurement equivalence of these modes of data collection.

Background: Juvenile idiopathic arthritis (JIA) is a serious and potentially debilitating pediatric illness. Improved disease self-management may help to improve health outcomes., Objective: This study aimed to evaluate the effectiveness of the Teens Taking Charge Web-based self-management intervention in reducing symptoms and improving health-related quality of life (HRQL) in adolescents with JIA compared with a Web-based education control condition., Methods: Adolescents with JIA aged 12 to 18 years were recruited from 11 Canadian pediatric rheumatology centers. Caregivers were invited to participate along with their child. In addition to standard medical care, participants were randomized to receive either (1) the Teens Taking Charge self-management intervention or (2) a Web-based education control condition for a period of 12 weeks. Adolescents in the intervention group completed website modules addressing cognitive behavioral coping skills, stress management, and other self-management topics, while also receiving monthly telephone calls from a trained health coach. Adolescents in the education control group were instructed to view a series of preselected public JIA educational websites and received monthly calls from a coach who asked about their own best efforts at managing JIA. Caregivers in the intervention group completed website modules related to promoting independence and disease self-management in their child. Caregivers in the education control group were instructed to view a series of preselected public JIA educational websites. Outcome assessment occurred at baseline, 12 weeks (posttreatment), and at 6 and 12 months postrandomization. The primary outcomes were pain intensity, pain interference, and HRQL. Secondary outcomes were emotional symptoms, adherence, coping, knowledge, and self-efficacy., Results: In total, 333 adolescents and 306 caregivers were enrolled. Significant overall reductions in pain intensity (P=.02) and pain interference (P=.007) were observed for intervention group participants compared with those in the education control group, after adjusting for baseline levels. There was a significant overall improvement in HRQL related to problems with pain (P=.02) and problems with daily activities (P=.01). There was also a significant difference in the intervention group over time (P=.008) for HRQL related to treatment problems, with the intervention group participants demonstrating improved HRQL by 12 months compared with education control group participants. Both groups showed nonsignificant improvements compared with baseline in other primary outcomes. There were no significant differences between the groups in any secondary outcomes or caregiver-reported outcomes., Conclusions: The results of this randomized trial suggest that the Teens Taking Charge Web-based intervention is effective at reducing both pain intensity and pain interference, as well as improving HRQL in adolescents with JIA, compared with education control. These effects are sustained for up to 12 months following program completion. The Teens Taking Charge program is now publicly available at no cost., Trial Registration: ClinicalTrials.gov NCT01572896; https://clinicaltrials.gov/ct2/show/NCT01572896., (©Jennifer N Stinson, Chitra Lalloo, Amos S Hundert, Sarah Campillo, Tania Cellucci, Paul Dancey, Ciaran Duffy, Janet Ellsworth, Brian M Feldman, Adam M Huber, Nicole Johnson, Geert't Jong, Kiem Oen, Alan M Rosenberg, Natalie J Shiff, Lynn Spiegel, Shirley M L Tse, Lori Tucker, Joseph Charles Victor. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 29.07.2020.)

Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficient in the treatment of depression. However, the optimal mode and intensity of therapist support remain to be identified. Scheduled telephone support (STS) may improve adherence and outcomes but, as it is time- and resource-consuming, should be reserved for patients for whom the usual support may be insufficient., Objective: This paper aims to reveal whether add-on STS for patients at risk of dropping out improves treatment adherence and symptoms in iCBT for depression., Methods: Among patients participating in an ongoing large observational routine clinical practice study of iCBT for depression delivered nationwide by Helsinki University Hospital (HUS-iCBT), those demonstrating a ≥14-day delay in initiation of treatment received invitations to this subsidiary STS study. A total of 100 consenting patients were randomly allocated to either HUS-iCBT as usual (control group, n=50) or HUS-iCBT plus add-on STS (intervention group, n=50). Proportions of those reaching midtreatment and treatment end point served as the primary outcome; secondary outcomes were change in Beck Depression Inventory (BDI)-measured depressive symptoms and time spent in treatment., Results: Add-on STS raised the proportion of patients reaching midtreatment compared with HUS-iCBT as usual (29/50, 58% vs 18/50, 36%; P=.045) and treatment end point (12/50, 24% vs 3/50, 6%; P=.02). Change in BDI score also favored add-on STS (3.63 points vs 1.1 points; P=.049), whereas duration of treatment did not differ., Conclusions: Add-on STS enhances adherence and symptom improvement of patients at risk of dropping out of iCBT for depression in routine clinical practice., Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 55123131; http://www.isrctn.com/ISRCTN55123131., (©Satu Pihlaja, Jari Lahti, Jari Olavi Lipsanen, Ville Ritola, Eero-Matti Gummerus, Jan-Henry Stenberg, Grigori Joffe. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.07.2020.)

Background and Purpose: Hospital pharmacists routinely receive and answer drug information questions via telephone while performing order verification. This report describes the development, implementation, and evaluation of a mock learning experience for student performance of these tasks in a health-systems pharmacy laboratory course., Educational Activity and Setting: An active learning skills-based exercise involving students receiving and answering a standardized drug information question via telephone during an order verification activity, referred to as a cold-call exercise, was developed and implemented. Data collected included student grades on a baseline assessment, the cold call exercise, order verification exercises, and student perceptions from a voluntary post-exercise survey. Student performance on the cold-call exercise was further evaluated via individual sections of the cold-call rubric. Data were summarized using descriptive statistics. Thematic analysis of student opinion and an estimate of faculty time were also executed., Findings: Student grades on the cold call and order verification exercises were 86.14% and 88.8%, respectively. Students often failed to ask category-specific questions because they did not categorize the ultimate question appropriately. Students found the activity organized and applicable. Time dedicated to creation was extensive, but execution and grading were reasonable., Summary: Students performed well on the drug information exercise as well as the order verification component. Students and faculty enjoyed the experience, and students found the exercise relevant and challenging. This exercise could be implemented into any pharmacy curriculum in order to prepare students using authentic learning experiences., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels., Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type., Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service-focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics., Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23%) and the highest survey completion rate (91.24%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14%) yet the lowest survey completion rate (74.0%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95% CI 1.23-1.88), married (aOR 1.52, 95% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95% CI 1.67-2.82), have a household income ≥US $25,000 a year (aOR 2.02, 95% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95% CI 1.27-1.83 for good-to-excellent health)., Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service-based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health., (©Kassandra I Alcaraz, Rhyan N Vereen, Donna Burnham. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.04.2020.)

Background: A recent review of primary care serious incidents suggests that diagnosis and assessment problems, underpinned by communication failures, involving the UK telephone triage service, NHS 111, may contribute to patient harm., Methods: The present study utilised conversation analysis to address the lack of evaluative research examining the NHS 111 system and in particular interactions between system components (call handler, computerized decision support system, patients/caller)., Results: Analysis of audio recorded call interactions revealed interactional misalignment across four mapped call phases (eliciting caller details, establishing reason for call, completing the Pathways assessment, and agreeing the outcome). This misalignment has the capacity to increase the risk of system failure, particularly in relation to assessment problems and issues related to the accurate transfer of care advice. Our analysis suggests that efforts to enhance the NHS 111 system, similar telehealth services, and patient safety management more generally, should shift their focus from a limited set of individual components towards a system-specific interactionist perspective encompassing all elements., Conclusions: Further evaluative research is required in order to build a comprehensive evidence-base concerning the multiple interacting factors influencing patient safety in the NHS 111 system., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aim: To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care., Background: Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments., Methods: Cross-sectional descriptive analysis., Results: Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high., Conclusions: The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders., Implications for Nursing Management: Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity., (© 2019 John Wiley & Sons Ltd.)

Even though dealing with septic patients, the communication of the Gram stain result of positive blood cultures is postponed in most laboratories outside of conventional working hours. There is little evidence from clinics that this issue is being addressed. This study evaluates the potential benefit of an around-the-clock communication. Therefore, the effect of the communication on the antibiotic treatment and the delay of the communication during our non-office hours were measured. Over a three-month period, all blood cultures which were positive for the first time outside the normal working hours were analyzed. Two standardized telephone calls were used to compare the antibiotic treatment before and after the communication of the Gram stain result. The evaluation of the antibiotic treatment was based on the final testing result. In total, 135 patients were included. The rate of the adequate antibiotic increased by 8 percentage points to 69%. The average delay in the patients adjusted to an adequate treatment was 8:57 h (range 2:16-16:59). This prospective study shows a benefit of the immediate communication. Nevertheless, this benefit seems to be partly the result of suboptimal adherence to the guidelines regarding empirical antibiotic treatment. This prospective study has been registered in the German Clinical Trials Register under the identifier DRKS00014996 ( http://www.drks.de/DRKS00014996 ).

In this document, the Commission announces that the Office of Management and Budget (OMB) has approved, for a period of three years, the information collection associated with rules adopted in the Commission’s document Access to Telecommunication Equipment and Services by Persons with Disabilities; Amendment of the Commission’s Rules Governing Hearing Aid-Compatible Mobile Handsets et. al., Report and Order and Order on Reconsideration (Order). This document is consistent with the Order, which stated that the Commission would publish a document in the Federal Register announcing the effective date of those rules.

Background: Failure modes and effects analysis (FMEA) is a tool used to identify potential risks in health care processes. We used the FMEA tool for improving the process of consultation in an academic medical center., Methods: A team of 10 staff members-5 physicians, 2 quality experts, 2 organizational consultants, and 1 nurse-was established. The consultation process steps, from ordering to delivering, were computed. Failure modes were assessed for likelihood of occurrence, detection, and severity. A risk priority number (RPN) was calculated. An interventional plan was designed according to the highest RPNs. Thereafter, we compared the percentage of completed computer-based documented consultations before and after the intervention., Results: The team identified 3 main categories of failure modes that reached the highest RPNs: initiation of consultation by a junior staff physician without senior approval, failure to document the consultation in the computerized patient registry, and asking for consultation on the telephone. An interventional plan was designed, including meetings to update knowledge of the consultation request process, stressing the importance of approval by a senior physician, training sessions for closing requests in the patient file, and reporting of telephone requests. The number of electronically documented consultation results and recommendations significantly increased (75%) after intervention., Conclusion: FMEA is an important and efficient tool for improving the consultation process in an academic medical center.

Objective: Compliance with post-operative follow-up in the context of international surgical trips is often poor. The etiology of this problem is multifactorial and includes lack of local physician involvement, transportation costs, and work responsibilities. We aimed to better understand availability of communication technologies within Belize and use this information to improve follow-up after visiting surgical trips to a public hospital in Belize City. Accordingly, a 6-item questionnaire assessing access to communication technologies was completed by all patients undergoing evaluation by a visiting surgical team in 2014. Based on this data, a pilot program for patients undergoing surgery was instituted for subsequent missions (2015-2016) that included a 6-week post-operative telephone interview with a visiting physician located in the United States., Results: Fifty-four (n = 54) patients were assessed via survey with 89% responding that they had a mobile phone. Patients reported less access to home internet (59%), local internet (52%), and email (48%). Of 35 surgical patients undergoing surgery during 2 subsequent surgical trips, 18 (51%) were compliant with telephone interview at 6-week follow-up. Issues were identified in 3 (17%) patients that allowed for physician assistance. The cost per patient interview was $10 USD.

The use of a follow-up card and telephone calls appeared to be an efficient modality for postdischarge surveillance of surgical site infections (SSIs) in Cambodia. One hundred and sixty-one patients were given a follow-up card and asked to present it to any healthcare practitioner they visited during the 30 days following their surgery. Patients were subsequently telephoned to collect information. After discharge, 87% of the patients provided follow-up data. Of these, 25 patients with no SSIs detected during hospitalization reported that 'white liquid had discharged from the surgical wound'; among them, nine cases of purulent drainage were reported by a practitioner., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

I was losing before I had begun. The line was crackly and the general hubbub in the office was making it even harder to hear.

Objective: Our aim was to evaluate caregivers' perceptions of a video, telephone follow-up, and online forum as components of a psychoeducational intervention., Method: Qualitative semistructured face-to-face interviews were conducted with 12 participants two weeks post-intervention. The study was conducted from September of 2012 to May of 2015. Family caregivers were recruited from four home hospice organizations (HCA Hospice Care, Metta Hospice, Singapore Cancer Centre, and Agape Methodist Hospice) and the National Cancer Centre outpatient clinic in Singapore. A purposive sample was employed, and participants were recruited until data saturation. Qualitative interviews were transcribed verbatim. Transcripts were coded and analyzed using content analysis. Two of the research team members were involved in the data analysis., Results: Two-thirds of participants were females (n = 8). Their ages ranged from 22 to 67 (mean = 50.50, SD = 11.53). About two-thirds were married (n = 7). Most participants were caring for a parent (n = 10), one for a spouse, and one for her mother-in-law. Caregivers favored the use of video for delivery of educational information. They liked the visual and audio aspects of the video. The ability to identify with the caregiver and scenarios in the video helped in the learning process. They appreciated telephone follow-ups from healthcare professionals for informational and emotional support. The online forum as a platform for sharing of information and provision of support was not received well by the caregivers in this study. The reasons for this included their being busy, not being computer savvy, rarely surfing the internet, and not feeling comfortable sharing with strangers on an online platform., Significance of Results: This study provided insight into caregivers' perceptions of various components of a psychoeducational intervention. It also gave us a better understanding of how future psychoeducational interventions and support for caregivers of persons with advanced cancer could be provided.

Background: Rates of readmission to hospital within 30 days are highest amongst those with chronic diseases. Effective interventions to reduce unplanned readmissions are needed. Providing support to patients with chronic disease via telephone may help prevent unnecessary readmission. This systematic review aimed to determine the methodological quality and effectiveness of interventions utilising telephone follow up (TFU) alone or in combination with other components in reducing readmission within 30 days amongst patients with cardiovascular disease, chronic respiratory disease and diabetes., Methods: A systematic search of MEDLINE, the Cochrane Library and EMBASE were conducted for articles published from database inception to 19(th) May 2015. Interventions which included TFU alone, or in combination with other components, amongst patients with chronic disease, reported 30 day readmission outcomes and met Effective Practice and Organisation of Care design criteria were included. The titles and abstracts of all identified articles were initially assessed for relevance and rejected on initial screening by one author. Full text articles were assessed against inclusion criteria by two authors with discrepancies resolved through discussion., Results: Ten studies were identified, of which five were effective in reducing readmissions within 30 days. Overall, the methodological quality of included studies was poor. All identified studies combined TFU with other intervention components. Interventions that were effective included three studies which provided TFU in addition to pre-discharge support; and two studies which provided TFU with both pre- and post-discharge support which included education, discharge planning, physical therapy and dietary consults, medication assessment, home visits and a resident curriculum. There was no evidence that TFU and telemedicine or TFU and post-discharge interventions was effective, however, only one to two studies examined each of these types of interventions., Conclusions: Evidence is inconclusive for the effectiveness of interventions utilising TFU alone or in combination with other components in reducing readmissions within 30 days in patients with chronic disease. High methodological quality studies examining the effectiveness of TFU in a standardised way are needed. There is also potential importance in focusing interventions on enhancing provider skills in patient education, transitional care and conducting TFU.

Background: Problems experienced after hospital discharge can result in rehospitalizations and unscheduled urgent and emergent care., Objective: To identify opportunities for improving discharge processes by examining calls to an advice line (AL)., Design: Prospective cohort., Setting: A 500-bed, university-affiliated hospital., Patients: Patients who called an AL between September 1, 2011 and September 1, 2012 and reported being hospitalized within 30 days., Intervention: None, Measurements: Caller characteristics, timing of calls, nature of reported problems., Results: Over 1 year the AL received calls from 308 unique patients who were hospitalized or had outpatient surgery within 30 days preceding the call. Thirty-one percent and 47% of calls occurred within 24 or 48 hours of discharge, respectively. Sixty-three percent came from surgery patients despite surgery patients accounting for only 38% of the discharges. The most common issues were uncontrolled pain, questions about medications, and aftercare instructions (eg, the care of surgical wounds). The rates of 30-day readmissions and urgent or emergent care visits were higher for patients who called the AL than for those who did not (15% vs 4% and 30% vs 7%, respectively, both P < 0.0001), but sample sizes were too small to accommodate robust matching or multivariate analysis., Conclusions: Problems described in calls by patients to an AL identified several aspects of our discharge processes that needed improvement. Patients calling an AL following discharge may be at increased risk for 30-day rehospitalization and urgent or emergent care visits., (© 2014 Society of Hospital Medicine.)

A 'health-literate organisation' recognises that miscommunication is very common and can negatively affect consumer care and outcomes, and makes it easier for people to navigate, understand, and use health information and services. This paper reports on the First Impressions Activities conducted by consumers to assess aspects of the literacy environment of a rural health service. The First Impressions Activities consists of three tools to assist health services to begin to consider some of the characteristics of their organisation that help and hinder a consumer's ability to physically navigate their way to and about the health service. The results show that navigation to and within the rural health service was made more complex due to lack of information, difficulty finding information, inconsistent terminology used in signage, missing signage, signage obscured by foliage, and incorrect signage.

This report describes the baseline experience of the multicenter, Home-Based Assessment study, designed to develop methods for dementia prevention trials using novel technologies for test administration and data collection. Nondemented individuals of 75 years of age or more were recruited and evaluated in-person using established clinical trial outcomes of cognition and function, and randomized to one of 3 assessment methodologies: (1) mail-in questionnaire/live telephone interviews [mail-in/phone (MIP)]; (2) automated telephone with interactive voice recognition; and (3) internet-based computer Kiosk. Brief versions of cognitive and noncognitive outcomes were adapted to each methodology and administered at baseline and repeatedly over a 4-year period. "Efficiency" measures assessed the time from screening to baseline, and staff time required for each methodology. A total of 713 individuals signed consent and were screened; 640 met eligibility and were randomized to one of 3 assessment arms; and 581 completed baseline. Dropout, time from screening to baseline, and total staff time were highest among those assigned to internet-based computer Kiosk. However, efficiency measures were driven by nonrecurring start-up activities suggesting that differences may be mitigated over a long trial. Performance among Home-Based Assessment instruments collected through different technologies will be compared with established outcomes over this 4-year study.

The CMS has proposed paying physicians for managing patients apart from face-to-face office visits. Among the details under consideration are requiring practices to use an electronic health-record system that supports access to care, care coordination, care management and communications. "It's a step in the right direction. The devil will be in the details and, if the burden of documentation is so high, people may choose not to spend their time doing it," says Dr. Matt Handley, physician and medical director for quality at the Group Health Cooperative.

This study examined therapist adherence and competence of the first telephone-based Acceptance & Commitment Therapy (ACT) intervention for smoking cessation. An independent rater assessed 100% (n=54 sessions) of the recorded phone sessions for adherence and competence on a 1 (never addressed) to 5 (addressed extensively) scale. A separate 20% random sample was rated by both the same independent rater and a second independent rater. The two coders were in perfect agreement (kappa of 1.0). Overall adherence (x=4.61, SD=0.63) and competence (x=4.81, SD=0.39) was high. Except self-as-context, benchmark ratings (i.e., 4 or more) were between 93% and 100%. Results suggest ACT therapy can be delivered competently over the telephone, opening many options for future research on the potential uses of telephone-based ACT for smoking and other behaviors., (Published by Elsevier Ltd.)

Background: The federally funded National HIV/AIDS Clinicians' Consultation Center (NCCC) offers US health care providers expert telephone consultations for managing HIV/AIDS and occupational exposures to blood-borne pathogens through 3 telephone services: the National Clinicians' Post-Exposure Prophylaxis Hotline (PEPline), the National HIV Telephone Consultation Service (Warmline), and the Perinatal HIV Hotline. Callers to the NCCC receive consultation from either a clinical pharmacist (PharmD) or a physician (MD) with HIV expertise., Objective: To compare the satisfaction of NCCC callers who received clinical consultations from clinical pharmacists and physicians with HIV expertise., Methods: We prospectively mailed 1256 satisfaction surveys to NCCC health care provider callers during a 7-month period. Survey recipients were not aware that satisfaction surveys compared PharmD and MD consultation services. Respondents rated their level of agreement with 8 statements about the quality of consultation, the quality of clinical information given, and future calls to the NCCC., Results: Survey return rates were 43% for PEPline and 40% for Warmline and Perinatal HIV Hotline combined. Overall, caller satisfaction with the telephone consultation service was extremely high (>4 in all categories on a 1-5 Likert scale). There was no significant difference in PEPline caller satisfaction ratings between PharmD and MD consultations. Callers to the Warmline and Perinatal HIV Hotline agreed with all 8 satisfaction statements. For the following 3 statements, however, satisfaction was higher when Warmline and Perinatal HIV Hotline consultation was provided by an MD: "Overall, I was pleased with the quality of my consultation" (p = 0.04); "I would use this service again" (p < 0.02); and "I am likely to recommend this service to my colleagues" (p = 0.02)., Conclusions: Health care provider callers to the NCCC were highly satisfied with the information obtained from this HIV/AIDS telephone consultation service. By measuring callers' survey response to PharmD and MD consultations, the importance of the clinicians' contributions to this advanced HIV/AIDS consultation service is documented.

Like many others, the St. Louis Veterans Administration Medical Center (VAMC) Pharmacy help desk receives far more calls than can be processed by current staffing levels. The objective of the study is to improve pharmaceutical services provided by the call center, by using queueing theory and discrete event dynamic simulation to analyze incoming telephone traffic to the help desk. Queueing and simulation models using both archival and hand-gathered data over a 1-year period were created, compared, and presented in order to determine the minimum quantities of staff needed to reach the desired service threshold. The simulation model was validated in comparison with real-world data. Results suggest that telephone traffic congestion in this setting may be alleviated by increasing the number of staff responsible for telephone services from 2 to 6 throughout the week, with an additional one serving on Monday. Both queueing and simulative models can be used to improve overwhelm pharmacy call centers, by determining the theoretical minimal staff needed to reach a service threshold.

Objective: To assess the quality of communication skills of triagists, working at out-of-hours (OOH) centres, and to determine the correlation between the communication score and the duration of the telephone consultation., Methods: Telephone incognito standardised patients (TISPs) called 17 OOH centres presenting different clinical cases. The assessment of communication skills was carried out using the RICE-communication rating list. The duration of each telephone consultation was determined., Results: The mean overall score for communication skills was 35% of the maximum feasible. Triagists usually asked questions about the clinical situation correctly and little about the patients' personal situation, perception of the problem or expectation. Advice about the outcome of triage and self-care advice was usually given without checking for patients' understanding and acceptance of the advice. Calls were often handled in an unstructured way, without summarizing or clarifying the different steps within the consultation. There was a positive correlation of 0.86 (p<0.01) between the overall communication score and the duration of the telephone consultation., Conclusion: Assessment of communication skills of triagists revealed specific shortcomings and learning points to improve the quality of communication skills during telephone triage., Practice Implications: Training in telephone consultation should focus more on patient-centred communication with active listening, active advising and structuring the call. Apart from adequate communication skills, triagists need sufficient time for telephone consultation to enable high quality performance.

The reliability and validity of assessments and diagnoses made via home telehealth was measured in 42 patients with spinal cord injury. Two telehealth modalities were investigated: telephone-only contact and videoconferencing. The results were compared with a reference (gold-standard) method, the in-person assessment and diagnosis of skin integrity and pressure ulcers. The agreement on the presence of a pressure ulcer was excellent for both telephone and videoconferencing approaches (92% for telephone, 97% for videoconferencing). The diagnoses of the stage of pressure ulcer (on an ordinal scale of 0-4) made via telephone and videoconferencing showed substantial to almost perfect agreement with the in-person diagnoses (Spearman's rho of 0.76 and 0.83, respectively). There was a tendency for the measurements of wound volume to be somewhat larger in the telephone and videoconferencing modalities compared to those made in-person. Bland-Altman plots showed that videoconferencing gave substantially narrower 95% limits of agreement. The findings of the study indicate that telephone contact can be a useful tool for identifying the presence of a pressure ulcer, but videoconferencing is required to obtain an evaluation reasonably close to that of a home visit.

Objective: To audit response times by all acute NHS hospital switchboards in England for external incoming calls. As with any audit, we set out to draw attention to efficiencies and deficiencies in the system, highlight problems, and suggest the first steps towards improving standards in a very important and poorly acknowledged part of our healthcare system., Design: Telephone calls were made to hospital switchboards, and time to response was measured. The results were then audited., Setting: Acute hospital NHS Trust switchboards in England., Main Outcome Measures: Time to response by hospital switchboards. The target time was 20 seconds., Results: Only 36% of 219 hospital switchboards met the 20 second target, with the average answering time across all switchboards being 45 seconds. The best performer was University Hospital North Durham (mean = 1 second) and the worst Bristol Royal Infirmary (mean = 381 seconds). We found that automated answer systems substantially increase the answer time to an operator; the fastest automated service was at Princess Royal University Hospital, which was ranked 69th., Conclusions: We recommend a formal NHS-wide audit system for switchboard response times.

This study explored the diversity of emergency code telephone numbers currently in use in Australian hospitals and examined the feasibility of a standard emergency code telephone number for all Australian hospitals, based on the United Kingdom experience. An email and telephone convenience survey of Australian hospitals from six states and two territories was conducted. Of the 108 hospitals surveyed, seven did not use a telephone number system and used a button/pager system to call an emergency. Of the 101 hospitals surveyed that used a telephone number system, 40 different emergency telephone numbers were in place, and in nine hospitals the telephone number used for Code Blue (medical emergency) was different to the telephone number used for other emergency codes. With increasing mobility of staff across hospitals, uniformity of emergency code telephone numbers is required to reduce confusion, potential danger and improve staff response in emergency situations. A single Australian standard emergency telephone number for all Australian hospitals is advocated.

The aim of the present observational 4-week study was to document the feasibility and utility of telephone-based or Internet-based pain monitoring in patients with chronic cancer or noncancer pain, such as nociceptive or neuropathic pain, using transdermal fentanyl. Pain intensity, treatment tolerability, activities of daily living, quality of life, and patient and physician satisfaction were evaluated in 60 (60% women, 42% opioid-naive) chronic pain patients who were switched from oral pain therapy to transdermal fentanyl therapy because of persisting severe pain. When the total dataset of all patient entries was analyzed, treatment with transdermal fentanyl led to decreases in maximal and mean pain scores as reported by the patients (-14% and -19%, respectively, last observation carried forward vs. baseline). Pain reduction was more pronounced in opioid-naive than in opioid-experienced patients (-35% and -25% vs. baseline, respectively; P=0.03). Overall, impairment of daily activities was reduced by 23% with transdermal fentanyl. No effect was observed with regard to quality of life and use of rescue pain medication. Transdermal fentanyl was generally well tolerated. Most patients (60%) preferred the telephone-based to the Internet-based or Internet combined with telephone questionnaires. Patient preference was driven by age, whereby younger patients tended to prefer the Internet and older patients the telephone (mean age, 45 and 54 y, respectively; difference n.s.). Internet-based and telephone-based monitoring of the efficacy and tolerability of opioid treatment for chronic pain was feasible in daily practice and generally well accepted by patients and physicians. Future research will determine the relative contribution of these 2 new options for patient-physician interaction and delineate their role in improving chronic pain control.

Objectives: This study analyzed our family medicine department's after-hours telephone medicine systems at an academic health center from a patient safety perspective. The research questions were (1) What are the threats to patient safety associated with after-hours telephone medicine and (2) What kinds of errors are made during after-hours telephone medicine?, Methods: Subjects were patients at the University of Kentucky family medicine practice who called in to the after-hours answering service. Telephone interviews were conducted with 64 patients over 10 weeks. During the interviews, patients described their telephone medicine experience, identified any problems, and reported potential or actual harm (patient-identified threats to patient safety). Two registered nurses and one physician analyzed the patient narratives to identify threats to patient safety (medical personnel-identified threats to patient safety)., Results: Sixty-three analyzable patient interviews identified four instances (6%) of temporary physical harm. Two separate after-hours calls (3%) involved four medical errors with potentially serious consequences to patient safety (wrong dose, serious illness not ruled out). Fourteen calls (22%) involved events that could have threatened patient safety., Conclusions: Situations that threaten patient safety occur frequently in telephone medicine. Although this study is too small to draw strong conclusions, it suggests that there are risks to patient safety associated with after-hours telephone medicine.

Objectives: This case study examines the uses, perceived advantages and disadvantages, and expectations of videophone communication by a nursing home resident and a geographically distant family member., Methods: Interviews were conducted with these participants, one in person and one by phone., Results: Themes identified suggest that, with the added visual component, there are additional uses and psychosocial benefits of videophone communication when compared to the telephone for both nursing home residents and family members., Conclusion: The study suggests that the use of the technology is not only feasible in an institutional setting but also beneficial. Further research with larger groups is supported.

Purpose: This study evaluated the reliability of screening women for symptoms of postpartum depression by a telephone assessment after hospital discharge., Study Design: Correlational design with a convenience sample of women from a Midwestern community hospital., Methods: One hundred and twenty-six women agreed to participate prior to hospital discharge and 106 women were in the final sample (response rate 84%). Telephone contact was made 8 weeks after discharge, when the Postpartum Depression Screening Scale was administered., Results: Twenty-seven percent of the women screened had scores indicating moderate-to-severe depression (score range 60-128). Reliability coefficients were calculated on the data for the short and long forms of the PDSS, as well as for all seven subscales (alpha coefficients were .72 and .94, respectively, for the short- and long-form totals). Subscale scores for the 35-item form were as follows: sleeping/eating disturbances .80, anxiety/insecurity .77, emotional lability .82, mental confusion .80, loss of self .87, guilt/shame .82, and contemplating harming oneself.90. The correlation between the short-form total and the long-form total was r = .91 (p = < 01.) Studies using the PDSS as an in-person instrument were compared with scores for telephone screening, and the overall mean scores were similar., Conclusion: Telephone screening is a reliable method to screen for postpartum symptomatology that may occur later than the 6-week office visit. Women who are at risk, especially those who have a history of treatment for depression, current treatment for depression or increased anxiety, should be screened for postpartum depression symptomatology.

Objective: To identify opportunities for quality improvement in long-term care telephone medicine using a model of interdisciplinary focus groups., Design: Descriptive pilot project., Setting: Extended Care and Rehabilitation Center (ECRC), Durham VA Medical Center, Durham, North Carolina., Participants: Eight of 20 registered or licensed practical nurses and 4 of 6 geriatric medicine fellows voluntarily participated in this quality improvement project., Measurements: In two 45-minute focus groups, participants were asked to discuss 3 open-ended questions related to telephone medicine. Comments were recorded during the discussions; topical themes were identified by the authors., Results: Participant comments could be categorized into 4 domains describing the characteristics of nurses and physicians who practice the best telephone medicine: (1) provides the appropriate medical component of patient care; (2) appreciates contextual issues; (3) respects the other party's time and resources; and (4) possesses a collaborative attitude. The focus groups identified 5 quality improvement goals: (1) better nursing assessment and provision of patient information; (2) minimization of non-urgent calls after hours; (3) more decisive physician action (or explanation of inaction); (4) better physician familiarity with facility policies/logistics; and (5) better communication/paging system. The discussion format allowed nurses and physicians to identify and respond to potential barriers to improving quality in each area., Conclusion: Nurses and physicians appreciate unique aspects of long-term care telephone medicine and identify distinct barriers to improving practice. Interdisciplinary focus groups were a productive step toward understanding the telephone medicine experience in our facility and developing quality improvement interventions for both nurses and physicians.

This research sought to elicit HIV/AIDS peer counselors' perspectives about delivery formats for a counseling intervention. Peer counselors identified personal contact as the major advantage of the face-to-face format. Personal contact afforded counselors better opportunities to understand and assess clients' physical, emotional, and environmental status and allowed them to connect with peers in more concrete and personal ways. Being physically present was also a very direct and effective way to role model for other HIV-positive women. Peer counselors identified a number of inherent barriers and challenges to telephone interventions but also recognized potential logistic and personal advantages. Despite the overwhelming preference for the face-to-face intervention format, counselors acknowledged the potential for conducting successful peer counseling over the telephone. A significant finding was that the value and meaning of HIV/AIDS peer counselors' work transcended the limitations of either delivery format.

Background: In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care., Aim: To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction., Design of Study: We looked at randomised controlled trials, controlled studies, controlled before/after studies, and interrupted time series of telephone consultation or triage in a general healthcare setting., Setting: All healthcare settings were included but the majority of studies were in primary care., Method: We searched the Cochrane Central Register of Controlled Trials, EPOC specialised register, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register and checked reference lists of identified studies and review articles. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality., Results: Nine studies met our inclusion criteria: five randomised controlled trials; one controlled trial; and three interrupted time series. Six studies compared telephone consultation with normal care; four by a doctor, one by a nurse, and one by a clinic clerk. Three of five studies found a significant decrease in visits to GPs but two found an increase in return consultations. In general at least 50% (range = 25.5-72.2%) of calls were handled by telephone consultation alone. Of seven studies reporting accident and emergency department visits, six showed no difference between the groups and one--of nurse telephone consultation--found an increase. Two studies reported deaths and found no difference between nurse telephone consultation and normal care., Conclusions: Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction.

Toll-free lines for public insurance programs are a major point of entry to inquire about information. More than 1 million Californians are eligible for public insurance programs based on income but not yet enrolled. In 2000 and 2002, a "mystery-shopper" survey was conducted to ascertain overall effectiveness and interlanguage variation for information provided in Armenian, Cantonese, English, Farsi, Hmong, Khmer, Korean, Russian, Spanish, and Vietnamese. Although the 2002 study showed statistically significant improvements from 2000, many constructs remained problematic. In 2002, for example, statistically significant interlanguage variation was identified in discussing and checking eligibility for the program. Specifically, Spanish and Armenian callers were less likely than other language callers to have eligibility checked or deemed eligible. Removing barriers to enrollment in public insurance programs often requires political solutions, but improving customer service for the toll-free line necessitates efficiency and a focus on continuous quality improvement.

Context: Telephone-based disease management protocols have shown promise in improving outcomes in a number of medical and psychiatric disorders, but this approach to continuing care has received little study in alcohol- and drug-dependent individuals., Objective: To compare telephone-based continuing care with 2 more intensive face-to-face continuing care interventions., Design: A randomized 3-group clinical trial with a 2-year follow-up., Setting: Two outpatient substance abuse treatment programs, one community-based and the other at a Veterans Affairs medical center facility., Patients: Alcohol- and/or cocaine-dependent patients (N = 359) who had completed 4-week intensive outpatient programs., Interventions: Three 12-week continuing care treatments: weekly telephone-based monitoring and brief counseling contacts combined with weekly supportive group sessions in the first 4 weeks (TEL), twice-weekly cognitive-behavioral relapse prevention (RP), and twice-weekly standard group counseling (STND)., Main Outcome Measures: Percentage of days abstinent from alcohol and cocaine, total abstinence from alcohol and cocaine, negative consequences of substance use, cocaine urine toxicological results, and gamma-glutamyltransferase., Results: Participants in TEL had higher rates of total abstinence over the follow-up than those in STND (P<.05). In alcohol-dependent participants, 24-month gamma-glutamyltransferase levels were lower in TEL than in RP (P = .005). In cocaine-dependent participants, there was a significant group x time interaction (P = .03) in which the rate of cocaine-positive urine samples increased more rapidly in RP as compared with TEL. On percentage of days abstinent or negative consequences of substance use, TEL did not differ from RP or STND. Participants with high scores on a composite risk indicator, based on co-occurring alcohol and cocaine dependence and poor progress toward achieving intensive outpatient program goals, had better total abstinence outcomes up to 21 months if they received STND rather than TEL, whereas those with lower scores had higher abstinence rates in TEL than in STND (P = .04)., Conclusions: Telephone-based continuing care appears to be an effective form of step-down treatment for most patients with alcohol and cocaine dependence who complete an initial stabilization treatment, compared with more intensive face-to-face interventions. However, high-risk patients may have better outcomes if they first receive group counseling continuing care after completing intensive outpatient programs.

We conducted a systematic review of remote interpretation. Any published or unpublished research article that had telephone or videoconferenced interpretation as an intervention was included in the review. Nine articles were identified: seven on telephone and two on videoconferenced interpretation. Only one study was a randomized controlled trial. Remote interpretation was associated with shorter intervals between consultations, but there were no consistent differences in relation to consultation length. Client and doctor satisfaction was as good with remote interpretation as with face-to-face interpretation, but interpreters preferred face-to-face interpretation. Although the costs associated with remote interpreting are higher, especially in the case of videoconferencing, these may be offset by efficiency gains. The review suggests that remote interpretation is an acceptable and accurate alternative to traditional methods, although the associated costs are higher.

To test the feasibility of a small and simple system for telephonic transmission of 12-lead electrocardiograms (ECGs), 70 patients with acute coronary syndrome admitted to the cardiac care unit (CCU) were included in a feasibility study. The transmission system consisted of a belt with multiple electrodes, which was positioned around the chest. The ECG signal was sent to a call centre via a standard telephone line. In parallel, a standard 12-lead ECG was recorded on site. In a retrospective analysis, each lead of the transmitted ECG was compared with the on-site 12-lead ECG with regard to ST-segment changes and final diagnosis. In all 37 patients with acute ST-elevation myocardial infarction, the diagnosis was correctly established on the basis of telephone-transmitted ECGs. In 96% of limb and 88% of chest leads, ST elevations which were visible in standard ECGs were correctly displayed on telephonically transmitted ECGs. In the remaining 33 patients no false-positive diagnosis was made using transtelephonic ECG analysis. A control group of 31 patients without apparent heart disease showed high concordance between standard ECGs and telephonically transmitted ECGs. Telephonically transmitted 12-lead ECGs interpreted by a hospital-based internist/cardiologist might allow a rapid and accurate diagnosis of ST-elevation myocardial infarction and may increase diagnostic safety for the emergency staff during prehospital decision making and treatment of acute myocardial infarction.

The comparability of information collected through telephone interviews and information collected through mailed questionnaires has not been well studied. As part of the first phase of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors compared histories of skin examination reported in telephone interviews and self-administered mailed questionnaires. A total of 1,270 subjects each completed a telephone interview and a mailed questionnaire 1 month apart in 1999; 564 subjects received the interview first, and 706 received the mailed questionnaire first. Agreement between the two methods was 91.2% and 88.6% for whole-body skin examination by a physician in the last 12 months and the last 3 years, respectively, and 81.9% for whole-body skin self-examination in the last 12 months. Agreement was lower for "any" skin self-examination. Agreement between the two methods was similar regardless of whether the interview or the questionnaire was administered first. Missing data were less frequent for interviews (0.5%) than for mailed questionnaires (3.8%). Costs were estimated at A$9.55 (US$6.21) per completed interview and A$3.01 (US$1.96) per questionnaire. The similarity of results obtained using telephone interviews and mailed questionnaires, coupled with the substantially higher cost of telephone interviews, suggests that self-administered mailed questionnaires are an appropriate method of assessing this health behavior.

One hundred and sixty-four consecutive patients attending a busy respiratory outpatient service were asked how acceptable was the concept of alternating face to face consultation with consultation by either telephone or email. The patients were then assessed as to their suitability for such non-traditional methods of consultation. Thirty patients (18.3%) were not agreeable to other forms of consultation and five could not speak English. One hundred and thirty-three (84%) had a suitable daytime telephone number for consultation purposes, but only 34 (21%) had email access, with this being commoner in the younger ages. One hundred and five patients were not thought to be suitable for alternative methods of consultation because of: the severity of their condition, the difficulty of assessing it over the telephone, or because they needed to attend the hospital for investigations. However, even in a clinic where the policy was already to return as many patients as possible to the care of their primary care physicians, and in a clinic where much work was already shared with respiratory nurse specialists, over one-third of patients were thought to be suitable for alternating face to face with telephone consultation. The diagnoses in those cases included asthma, suspected obstructive sleep apnoea, chronic obstructive pulmonary disease (COPD), unexplained cough, and some patients with respiratory malignancy being visited at home by the palliative medicine services. However, for those with asthma and for those awaiting results of investigations especially, use of telephone consultation appears to be an acceptable and convenient way of reducing the pressure upon time available for face to face consultations.