Family Practice Vol. 19, No. 5, 516-519
© Oxford University Press 2002
Health Services Research |
The implementation of a call-back system reduces the doctor’s workload, and improves accessibility by telephone in general practice
Department of Family Practice, University of Groningen, Antonius Deusinglaan 4, 9713 AW Groningen, The Netherlands.
Mr RA de Groot, De Klokkemaat 2, 8375 HC Oldemarkt, The Netherlands; E-mail: hapo{at}radegroot.demon.nl
de Groot RA, de Haan J, Bosveld HEP, Nijland A and Meyboom-de Jong B. The implementation of a call-back system reduces the doctor’s workload, and improves accessibility by telephone in general practice. Family Practice 2002; 19: 516–519.
Received 26 May 2001; Revised 12 November 2001; Accepted 13 May 2002.
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Abstract |
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Background. In a general practice in The Netherlands, the demand for direct telephone consultation with the doctor became extreme, which resulted in poorly managed consultations, and poor telephone access due to busy lines. A call-back telephone appointment system was therefore introduced: all calls are answered and, when possible, managed by the practice assistant. If the assistant feels incapable, or if the patient prefers to speak to the doctor, a telephone appointment is scheduled, at which time the doctor returns the patient’s call.
Objective. Our aim was to evaluate the effects of a call-back telephone appointment system on doctors’ workload and patients’ telephone access to doctors.
Methods. Telephone consultation data over 10 weeks were selected before and after the introduction of the call-back telephone appointment system. The outcomes measured were: number and duration of telephone calls to doctors, the reason for each call and how often telephone lines were engaged during the specified telephone hour.
Results. The number of calls requiring the doctor’s attention was reduced by 59% and total time spent on the telephone by the GPs was reduced by 39%. This reduction is explained by a change in the reasons for calling. Telephone accessibility improved, as busy telephone lines were no longer an issue.
Conclusion. The call-back telephone appointment system is superior to the previously used open access telephone hour.
Keywords. Telephone consultation, telephone management, workload.
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Introduction |
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Patients and GPs agree that it should be possible to consult directly with the doctor by telephone.1,2 Reserving a specific period of time for doctor–patient calls is recommended.3 Patients were satisfied with the help they received over the telephone from doctors, but were less satisfied with the process of contacting the doctor.2
In a general practice in the north of The Netherlands, the patient demand for direct consultation with the doctor by telephone became extreme. During the special telephone hour for doctors, all telephone calls were answered directly by the doctors, without mediation of the practice assistant. A practice assistant, a job for which one has to pass a 3-year training course, fulfils reception tasks as well as medical tasks in Dutch general practice.
A survey of the doctor–patient telephone calls revealed the following: there were an average of 22 incoming patient calls per telephone consulting hour, and the telephone was busy an average of 165 times during every telephone consulting hour.4 The survey further revealed that many of these calls could have been managed adequately by the practice assistant.4 A change in telephone management was therefore considered. Instead of the current open access telephone system, an appointment system would be implemented.5 According to this system, the practice assistant would answer all the calls, and manage them when possible. Only if the assistant felt herself incapable of managing the call, or if the patient preferred to speak to the doctor, would she schedule a telephone appointment for the patient, at which time the doctor would return the patient’s call: the call-back system. This would take place during a special telephone consultation hour, from 1 to 2 p.m. Doctors do not answer any calls directly, giving the assistants the opportunity to screen all incoming calls.
The present study examines the effects of this change in telephone policy on the doctor’s workload and on the doctor’s accessibility by telephone for patients.
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Methods |
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Telephone policy
During daytime working hours, from 8 a.m. to 5 p.m., the three practice assistants answered all the calls, except for the calls which came in during the designated consultation hour, which was from 1 to 2 p.m.
The baseline study
Before the intervention, the amount of time which the doctor spent handling telephone calls from patients was examined during a 10-week period from 6 January to 15 March 1997.4 During this period, all telephone calls to the doctors were registered. The time and duration of the call, the demographics of the caller, the reason for the call and the duration of each telephone call were registered. The reason for the call was coded according to the International Classification of Primary Care.6
The intervention
The call-back system, a new telephone appointment system, with the doctors returning the patients’ calls, was introduced on 1 April 1997.
To measure the effects of the change to the call-back system on the doctor’s workload, all telephone calls to the doctors were registered again during a 10-week period, from 5 January until 14 March 1998, exactly 1 year after the baseline study, using the same pre-coded registration form.
The effect of the call-back system on the patients’ telephone access was assessed by comparing how often the three regular telephone lines were engaged between 1 and 2 p.m. before and after the intervention during a 1-week period.
Data were analysed using SPSS 9.0. Categorical data were subjected to chi-square analysis. Means were compared using the Student’s t-test. A P-value <0.05 was regarded as significant.
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Results |
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Table 1
shows that the total number of calls per hour was reduced by 59%, and the time spent on the telephone by the GPs was reduced by 39%.
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There was no significant change in patient demographics. All the reasons for calling decreased in frequency (Table 2
). The proportions in which the various reasons occurred were different after implementation of the call-back system. Specific medical concerns were the main reason for the patient’s call, increasing from 45% before to 69% after the intervention. Table 3 presents a breakdown of those complaints occurring more than six times. There is a large variety of medical complaints with a low prevalence.
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The telephone lines generally were not busy during the 1-week test period, which followed the intervention. The Thursday of that week was the only exception, when the lines were found to be engaged nine times during the 1 h test period. This may be compared with a daily average of 165 times before the telephone policy was changed.
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Discussion |
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The present study shows that the change in telephone policy reduced the doctors’ workload by 39%. This reduction can be explained by examining the reasons for the telephone calls. First, calls for test results which were not yet available, and calls for other physicians virtually disappeared after the policy change. Secondly, the number of calls by patients requesting test results decreased notably. It is likely that the practice assistant was able to handle the majority of these calls. The call-back system placed the practice assistant in a triage position, allowing him/her to filter out the calls which would require the attention of the doctors, thereby effectively reducing the doctors’ telephone workload. Telephone triage by trained nurses previously has been shown to be safe.7,8
A review of the reasons for calling reveals that the number of calls for coughing, fever, sinus problems, diarrhoea and low back pain declined notably. The practice assistant has clinical guidelines to follow in the above-mentioned instances. These guidelines are edited by the Dutch College of General Practitioners.
There was a shift in the proportions of the reasons for calling. Combined with the striking increase in the average duration of the calls, this could be an indication that the physician is now handling the proper calls in a proper way, with the other calls being managed by the practice assistant.
The new system facilitates the doctors’ telephone accessibility, as the telephone lines were virtually never engaged with the call-back telephone appointment system. The lower number of calls explains the better access to the doctor, and, secondly, the doctor may now decide when to phone the patient, spreading the calls out over the time period set aside for telephone consultation.
Patients benefit from this change in telephone management, as the duration of the telephone calls is longer, the number of calls followed by a visit to the surgery is reduced, and the telephone lines are less likely to be engaged when the patient calls.
The present study on telephone management showed evidence of the superiority of the call-back telephone appointment system over the previously used system, when there would be a telephone hour, during which the doctor would answer the phone him/herself. Additionally, this study showed the importance of a systematic approach in the solving of a problem concerning practice management. A simple change in telephone management has improved the doctors’ accessibility, and has reduced the inconvenience of immediately addressing patients’ concerns over the telephone.
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References |
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1 Hallam L. Organisation of telephone services and patients’ access to doctors by telephone in general practice. Br Med J 1991; 302: 629–632.[ISI][Medline]
2 Hallam L. Access to general practice and general practitioners by telephone: the patients’s view. Br J Gen Pract 1993; 43: 331–335.[ISI][Medline]
3 Hallam L. Patient access to general practitioners by telephone: the doctor’s view. Br J Gen Pract 1992; 42: 186–189.[ISI][Medline]
4 De Groot RA, De Haan J, Bosveld HEP, Meyboom-de Jong B. De telefoon: wat gaat er fout? Huisarts Wet 2001; 44: 16–17.
5 Starreveld JG. De dokter belt u terug. Een telefonisch afsprakenspreekuur. Huisarts Wet 1987; 30: 220–221.
6 Boersma JJ, Gebel RS, Lamberts H. ICPC, International Classification of Primary Care Short Titels en Nederlandse subtitels. NHG, 1995.
7 Gallagher M, Huddart T, Henderson B. Telephone triage of acute illness by a practice nurse in general practice: outcomes of care. Br J Gen Pract 1998; 48: 1141–1145.[ISI][Medline]
8 Lattimer V, George S, Thompson F et al. Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial. Br Med J 1998; 317: 1054–1059.
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