Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs

OBJECTIVE: To compare the workloads of general practitioners and nurses and costs of patient care for nurse telephone triage and standard management of requests for same day appointments in routine primary care. DESIGN: Multiple interrupted time series using sequential introduction of experimental triage system in different sites with repeated measures taken one week in every month for 12 months. SETTING: Three primary care sites in York. Participants: 4685 patients: 1233 in standard management, 3452 in the triage system. All patients requesting same day appointments during study weeks were included in the trial. MAIN OUTCOME MEASURES: Type of consultation (telephone, appointment, or visit), time taken for consultation, presenting complaints, use of services during the month after same day contact, and costs of drugs and same day, follow up, and emergency care. RESULTS: The triage system reduced appointments with general practitioner by 29-44%. Compared with standard management, the triage system had a relative risk (95% confidence interval) of 0.85 (0.72 to 1.00) for home visits, 2.41 (2.08 to 2.80) for telephone care, and 3.79 (3.21 to 4.48) for nurse care. Mean overall time in the triage system was 1.70 minutes longer, but mean general practitioner time was reduced by 2.45 minutes. Routine appointments and nursing time increased, as did out of hours and accident and emergency attendance. Costs did not differ significantly between standard management and triage: mean difference £1.48 more per patient for triage (95% confidence interval -0.19 to 3.15). CONCLUSIONS: Triage reduced the number of same day appointments with general practitioners but resulted in busier routine surgeries, increased nursing time, and a small but significant increase in out of hours and accident and emergency attendance. Consequently, triage does not reduce overall costs per patient for managing same day appointments

Disease risks from foods, England and Wales, 1996-2000.

Data from population-based studies and national surveillance systems were collated and analyzed to estimate the impact of disease and risks associated with eating different foods in England and Wales. From 1996 to 2000, an estimated 1,724,315 cases of indigenous foodborne disease per year resulted in 21,997 hospitalizations and 687 deaths. The greatest impact on the healthcare sector arose from foodborne Campylobacter infection (160,788 primary care visits and 15,918 hospitalizations), while salmonellosis caused the most deaths (209). The most important cause of indigenous foodborne disease was contaminated chicken (398,420 cases, risk [cases/million servings] = 111; case-fatality rate [deaths/100,000 cases] = 35, deaths = 141). Red meat (beef, lamb, and pork) contributed heavily to deaths, despite lower levels of risk (287,485 cases, risk = 24, case-fatality rate = 57, deaths = 164). Reducing the impact of indigenous foodborne disease is mainly dependent on controlling the contamination of chicken

The role of the Intermediate Care Team in detecting and responding to loneliness in older clients

The Intermediate Care Team (ICT) supports patients in their own homes to manage complex needs. They are ideally placed in the community to identify older adults at risk of loneliness. However, little is known about how ICT professionals perceive, detect, or respond to loneliness in their clients. This study explores ICT professional’s attitudes to loneliness in the context of perceived service priorities and their experiences of managing loneliness in their clients. Eight ICT professionals (n=2 physiotherapists, n=3 occupational therapists, n=3 nurses) took part in semi-structured interviews. Data was analysed thematically using framework analysis, applying the Theory of Planned Behaviour as an interpretive framework. ICT professionals believed loneliness was a significant issue for many of their older clients but was a low priority for ICT services. Study participants believed that loneliness often goes undetected because it is an issue that is difficult to measure objectively. Barriers to managing loneliness included high work-load, unsatisfactory referral systems, and lack of close working with social-care and independent sector services. Introducing brief but reliable loneliness assessments into routine practice, receiving training on detecting and managing loneliness, and improving working relationships with social care and independent sector services were highlighted as strategies that could improve the detection and management of loneliness in ICT clients