The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews
The quality, safety and governance of telephone triage and advice services - an overview of evidence from systematic reviews
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DOI：
10.1186/s12913-017-2564-x
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发表时间：
2017-08-30
影响因子：
2.8
通讯作者：
Westbrook, Johanna I.
中科院分区：
文献类型：
--
作者：
Lake, Rebecca;Georgiou, Andrew;Westbrook, Johanna I.
背景：电话分类和咨询服务（TTAS）在世界各地越来越多地得到实施。这些服务允许人们通过电话与护士或全科医生交谈，并接受评估和保健建议。关于TTAS的主题已有大量研究，但证据基础的分散使得很难确定整个文献中一致的关键经验教训。系统评价是最高级别的证据综合。我们的目的是对这些综述进行概述，以确定与TTAS的治理、安全性和质量相关的研究结果的范围、一致性和普遍性。方法：我们检索PubMed、MEDLINE、EMBASE、CINAHL、Web of Science和Cochrane图书馆，检索自1990年以来发表的与电话分诊和咨询服务相关的关键治理、质量和安全性研究结果的英语系统综述。这项研究是由三位研究人员进行的，他们对所有纳入的系统评价达成了共识。系统评价的方法学质量的评估是由两位研究者使用测量工具评估系统评价独立进行的。结果：从291个潜在结果中选择10个系统评价纳入。对TTAS进行单独检查，或作为初级保健服务模式或旨在改善初级保健的干预措施的一部分进行检查。报告了TTAS绩效的证据，涉及九个关键指标——可及性、适当性、合规性、患者满意度、成本、安全性、卫生服务利用率、医生工作量和临床结果。患者对TTAS的满意度普遍较高，并且有一些一致的证据表明TTAS能够减少临床工作量。对TTAS安全性的测量倾向于显示TTAS与传统护理之间没有重大差异。结论：作为一个整体，目前的证据并没有提供关于所提供的护理质量、服务的可及性和公平性、其成本和结果等问题的明确答案。现有证据还表明，有许多相互影响的因素（例如，与其他保健服务提供者的关系）会影响绩效衡量，也会影响研究结果的外部有效性。
Background: Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS.Methods: We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews.Results: Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.Conclusions: Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings.