The Effectiveness of Telephonic Consultation in Primary Care

Primary care is the first point of contact for most people when they need health care services. It encompasses a range of services, such as prevention, diagnosis, treatment, rehabilitation, and palliative care, that are delivered by a variety of health professionals, such as physicians, nurses, pharmacists, and allied health workers. Primary care is essential for achieving universal health coverage, improving health outcomes, and reducing health inequalities.

However, primary care faces many challenges, such as increasing demand, workforce shortages, rising costs, and limited access. One way to address these challenges is to use telephonic consultation, which is a form of telehealth that involves communication between healthcare providers and patients via telephone. Telephonic consultation can offer many benefits, such as improving access, convenience, and choice for patients, reducing workload and travel time for providers, and lowering healthcare costs.

But how effective is telephonic consultation in primary care? How does it compare to face-to-face consultation in terms of clinical outcomes, patient satisfaction, and healthcare utilization? What are the best practices and challenges for implementing telephonic consultation in primary care settings? In this article, we will explore these questions and provide some evidence-based answers.

Clinical Outcomes

One of the main concerns about telephonic consultation is whether it can provide the same quality of care as face-to-face consultation, especially for complex or chronic conditions that may require physical examination, diagnostic tests, or follow-up visits. A systematic review of 36 studies comparing telephone or video consultations versus face-to-face visits in primary care, mental health, and allied health services found that teleconsultations were as effective as in-person visits in improving clinical outcomes in adults with mental health conditions and those attending primary care services.

For example, one randomized controlled trial involving 2,662 patients with diabetes, hypertension, or hyperlipidemia found that telephone care management by nurses, in addition to usual care, resulted in better glycemic, blood pressure, and cholesterol control than usual care alone Another randomized controlled trial involving 1,474 patients with depression found that telephone cognitive behavioral therapy, in addition to usual care, resulted in greater improvement in depressive symptoms, quality of life, and satisfaction than usual care alone.

However, the review also found that teleconsultations were not as effective as face-to-face visits for some conditions, such as asthma, chronic obstructive pulmonary disease, and musculoskeletal disorders, that may require more physical assessment or intervention. Therefore, teleconsultations may not be suitable for all patients or all conditions, and the decision to use teleconsultations should be based on the individual needs and preferences of the patients and the providers.

Patient Satisfaction

Another important aspect of telephonic consultation is whether it can meet the expectations and preferences of the patients, especially in terms of communication, convenience, and trust. A comparative study of 3,701 patients who had either a telephone or a face-to-face consultation with a primary care physician found that patient satisfaction was equally high for both modes of consultation, with over 90% of patients reporting that they were very or fairly satisfied with the consultation.

Moreover, the study found that patients who had a telephone consultation were more likely to report that the consultation was convenient, that they did not have to wait long, and that they had enough time to discuss their problems. Another study involving 1,474 patients with depression found that patients who received telephone cognitive behavioral therapy reported higher satisfaction with their treatment than those who received face-to-face therapy.

However, patient satisfaction with telephonic consultation may also depend on several factors, such as the reason for the consultation, the relationship with the provider, the availability of technology, and the quality of the communication. Some patients may prefer face-to-face consultation for certain conditions, such as skin problems, or for establishing rapport with a new provider. Some patients may also face barriers to telephonic consultation, such as lack of access to a telephone, privacy, or literacy. Therefore, telephonic consultation should be offered as an option, not a requirement, for patients who are willing and able to use it.

Health Care Utilization

A third aspect of telephonic consultation is whether it can reduce the demand and cost of health care services, such as emergency department visits, hospital admissions, or face-to-face consultations. A time series study of 20,858 patients who had either a telephone or a face-to-face consultation with a primary care physician found that telephone consultations did not reduce the overall number of face-to-face consultations over time, but rather increased the total number of consultations by 33%.

The study also found that telephone consultations did not reduce the number of emergency department visits or hospital admissions, but rather increased the number of referrals to secondary care by 38%. The authors suggested that telephone consultations may increase health care utilization by creating more demand from patients who would otherwise not consult, by lowering the threshold for providers to offer follow-up or referral, or by missing important signs or symptoms that require further investigation or intervention

However, other studies have found that telephonic consultation can reduce healthcare utilization and cost for certain populations or conditions. For example, one randomized controlled trial involving 2,662 patients with diabetes, hypertension, or hyperlipidemia found that telephone care management by nurses, in addition to usual care, resulted in lower healthcare costs than usual care alone, mainly due to fewer hospitalizations and emergency department visits. Another randomized controlled trial involving 1,474 patients with depression found that telephone cognitive behavioral therapy, in addition to usual care, resulted in lower health care costs than face-to-face therapy, mainly due to fewer outpatient visits and medications.

Therefore, the impact of telephonic consultation on health care utilization and cost may vary depending on the type, frequency, and quality of the telephonic consultation, as well as the characteristics of the patients and the providers.

Best Practices and Challenges

To ensure the effectiveness, safety, and quality of telephonic consultation in primary care, some best practices and challenges need to be considered;

  • Best practices include:
    • Establishing clear protocols and guidelines for telephonic consultation, such as the indications, contraindications, documentation, and follow-up.
    • Providing adequate training and support for health care providers and patients on how to use telephonic consultation, such as communication skills, technical skills, and ethical issues.
    • Ensuring appropriate triage and assessment of the patient’s needs and preferences, and offering telephonic consultation as an option, not a substitute, for a face-to-face consultation.
    • Maintaining a high standard of clinical care and patient safety, such as verifying the identity and consent of the patients, obtaining a comprehensive history and relevant information, making an accurate diagnosis and management plan, and prescribing safely and appropriately.
    • Evaluating the outcomes and satisfaction of telephonic consultation, and using feedback and data to improve the quality and efficiency of the service.
  • Challenges include:
    • Addressing the legal and regulatory issues related to telephonic consultation, such as the liability, confidentiality, and reimbursement of the providers and the patients.
    • Overcoming the technical and logistical barriers to telephonic consultation, such as the availability, accessibility, reliability, and security of the technology and the infrastructure.
    • Managing the clinical and interpersonal risks of telephonic consultation, such as the potential for miscommunication, misunderstanding, misdiagnosis, or missed opportunities.
    • Balancing the benefits and drawbacks of telephonic consultation, such as the convenience and accessibility versus the quality and continuity of care.

Conclusion

Telephonic consultation is a form of telehealth that can offer many advantages for primary care, such as improving access, convenience, and choice for patients, reducing workload and travel time for providers, and lowering health care costs. However, telephonic consultation is not a panacea for primary care, and it may not be suitable or effective for all patients or all conditions. Therefore, telephonic consultation should be used as a complementary, not a replacement, service for face-to-face consultation, and it should be implemented with clear protocols, guidelines, training, and evaluation to ensure its effectiveness, safety, and quality.

Facts and Figures Related to Primary Care

  • Over 1 billion people worldwide are at risk of falling into poverty due to out-of-pocket health spending of 10% or more of their household budget.
  • Scaling up primary healthcare interventions across low and middle-income countries could save 60 million lives and increase average life expectancy by 3.7 years by 2030.
  • The majority of essential interventions (90%) for universal health coverage can be delivered using a primary health care approach.
  • An estimated 75% of the projected health gains from the Sustainable Development Goals could be achieved through primary health care.
  • Achieving the targets for primary health care requires an additional investment of around US$ 200 to US$ 328 billion a year for a more comprehensive package of health services.
  • In the US, primary care accounts for about 55% of the 1 billion physician office