Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

BMC Family Practice

Research Article

Chris Salisbury¹  Colin Green²  Linnie Price²  David A Richards²  Nicky Britten²  John L Campbell³  Rod S Taylor³  Emily Fletcher³  Suzanne H Richards³  Raff Calitri³  Jamie Murdoch⁴  Anna Varley⁴  Valerie Lattimer⁴ 

[1] Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK;Institute of Health Service Research, University of Exeter Medical School, Exeter, UK;Primary Care Research Group, University of Exeter Medical School, Exeter, UK;School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK;

关键词: Telephone;    Triage;    General practice;    Primary health care;    Process evaluation;    Qualitative interviews;   

DOI  :  10.1186/s12875-015-0263-4

 received in 2015-02-02, accepted in 2015-03-30,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundTelephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation.The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff.MethodsThe intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff).ResultsStaff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage.ConclusionThe findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made.Trial registrationCurrent Controlled Trials ISRCTN20687662. Registered 28 May 2009.

【 授权许可】

CC BY   
© Murdoch et al.; licensee Biomed Central. 2015