Author Topic: Once again the US medical care system has a flaw  (Read 85 times)

0 Members and 1 Guest are viewing this topic.

Offline agate

  • Administrator
  • *****
  • Posts: 9821
  • MS diagnosed 1980
  • Location: Pacific Northwest
Once again the US medical care system has a flaw
« on: August 31, 2014, 07:18:55 am »
They did a study (in the UK) comparing patients' urgent phone calls to their doctors' offices and found that "telephone triage" was more effective, resulting in fewer face-to-face contacts between patient and doctor, than the more traditional system of scheduling the patient for a same-day office visit.

But

Quote
In many U.S. practices, however, delivering care by phone is impractical, because it is not reimbursed.



From the NEJM Journal Watch, August 26, 2014:

Quote
Telephone Triage in Primary Care Prevents Unnecessary Office Visits

Bruce Soloway, MD reviewing Campbell JL et al.
Lancet 2014 Aug 4. Osborn J and Thompson M. Lancet 2014 Aug 4.

Health outcomes were the same with or without a triage system.

Many primary care practices are seeking to improve quality of care and patient satisfaction without adding to workload or costs. In some practices, nurses or physicians triage urgent patient calls through initial telephone consultations rather than have receptionists schedule same-day office visits, but the effects of this strategy have not been measured in large-scale trials. Investigators in the U.K. randomized 42 primary care practices to telephone triage by physicians or by nurses (with computerized algorithm support) or to usual care. In triage practices, patients who called with urgent concerns received prompt return phone calls from nurses or physicians, who either addressed problems definitively by phone or planned further management by phone or in the office. Primary outcome data were available on 16,211 of 20,990 eligible callers.

During 28 days after initial patient contact, physician triage and nurse triage were associated with 33% and 48% more primary care contacts per patient (in-person plus phone) but 39% and 20% fewer face-to-face physician visits per patient than were generated by usual care. Mean duration of triage calls was 4 minutes for physicians and 6.5 minutes for nurses. Compared with usual-care patients, physician-triage patients reported easier phone access to primary care practices. Patients who received nurse triage reported lower overall satisfaction than usual-care and physician-triage recipients. All three strategies yielded equivalent health outcomes and similar costs.

COMMENT

These results suggest that triage systems can redistribute work and prevent unnecessary office visits without compromising patient care or adding to costs. In many U.S. practices, however, delivering care by phone is impractical, because it is not reimbursed.

MS Speaks--online for 17 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.