An assessment of the feasibility of telephone and email consultation in a chest clinic

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Abstract

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.

Introduction

Consultation time in busy respiratory clinics is inevitably limited. Attendance at hospital clinics is disruptive to patients’ lifestyle whether by impact on social events, or upon occupation. We need to consider therefore whether all consultations are necessary, and whether there are alternatives to the traditional face to face consultation. The use of telephone consultation has been studied in primary care, mostly looking at the giving of advice regarding acute medical conditions [1], [2], [3], but also in delivering advice regarding health behaviour [4]. In primary care, it has been estimated that as a result of telephone management of same day demand, there could be a 30–50% reduction in face to face consultations, and a 15–20% reduction in follow up consultations [5]. In secondary care, the use of telephone consultation has been shown to be very acceptable, for example, to patients attending a rheumatology clinic [6]. There is less published information on the use of email as a consultation method, although there are reports from the UK and USA on its use to access patient and disease-specific information [7], [8]. This report is of a preliminary study designed to assess the acceptability and feasibility of offering telephone or email consultation as an alternative to face to face consultation to patients attending a busy University Hospital outpatient chest clinic.

Section snippets

Methods

One hundred and sixty-four consecutive respiratory outpatients (32 with lung cancer or other intrathoracic malignancy, 19 with Asthma, 19 with tuberculosis, 18 with chronic obstructive pulmonary disease (COPD), 17 with obstructive sleep apnoea syndrome (OSAS), 11 with sarcoidosis, 7 with fibrosing alveolitis, 2 with cystic fibrosis and 30 with miscellaneous respiratory conditions) attending one consultant respiratory physician in the Chest Clinic at Whipps Cross University Hospital, London,

Results

Completed questionnaires were obtained from all 164 patients. Thirty patients (18.3%) reported that they would not find other forms of consultation acceptable, and five could not speak English.

Excluding those that could not speak English, 133/159 (83.7%) had a telephone number and nine more had access to a confidential telephone number in the evening. Only 34/159 (21.4%) had email access, with the majority of them (70%) being aged under 50 years.

One hundred and five patients were deemed

Discussion and conclusion

At a time when it is correct to offer a more patient centred approach to healthcare, it is appropriate to consider the feasibility and acceptability of alternative methods of consultation. Use of telephone consultation may be more convenient for busy patients and may save costs. Experience of usage has been reported to be very successful in a cystic fibrosis service [9], and in a general (internal) medicine service costs were 25% less in patients managed by telephone [10]. In respiratory

Acknowledgements

I am grateful to the receptionists and the Respiratory Nurse Specialists at Whipps Cross University Hospital for their help in offering the questionnaires to patients attending the chest clinic.

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