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Evaluation of telephone first approach to demand management in English general practice: observational study

Overview of attention for article published in British Medical Journal, September 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (96th percentile)

Mentioned by

news
9 news outlets
blogs
3 blogs
twitter
395 tweeters
facebook
9 Facebook pages

Citations

dimensions_citation
19 Dimensions

Readers on

mendeley
86 Mendeley
citeulike
1 CiteULike
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Title
Evaluation of telephone first approach to demand management in English general practice: observational study
Published in
British Medical Journal, September 2017
DOI 10.1136/bmj.j4197
Pubmed ID
Authors

Jennifer Newbould, Gary Abel, Sarah Ball, Jennie Corbett, Marc Elliott, Josephine Exley, Adam Martin, Catherine Saunders, Edward Wilson, Eleanor Winpenny, Miaoqing Yang, Martin Roland

Abstract

Objective To evaluate a "telephone first" approach, in which all patients wanting to see a general practitioner (GP) are asked to speak to a GP on the phone before being given an appointment for a face to face consultation.Design Time series and cross sectional analysis of routine healthcare data, data from national surveys, and primary survey data.Participants 147 general practices adopting the telephone first approach compared with a 10% random sample of other practices in England.Intervention Management support for workload planning and introduction of the telephone first approach provided by two commercial companies.Main outcome measures Number of consultations, total time consulting (59 telephone first practices, no controls). Patient experience (GP Patient Survey, telephone first practices plus controls). Use and costs of secondary care (hospital episode statistics, telephone first practices plus controls). The main analysis was intention to treat, with sensitivity analyses restricted to practices thought to be closely following the companies' protocols.Results After the introduction of the telephone first approach, face to face consultations decreased considerably (adjusted change within practices -38%, 95% confidence interval -45% to -29%; P<0.001). An average practice experienced a 12-fold increase in telephone consultations (1204%, 633% to 2290%; P<0.001). The average duration of both telephone and face to face consultations decreased, but there was an overall increase of 8% in the mean time spent consulting by GPs, albeit with large uncertainty on this estimate (95% confidence interval -1% to 17%; P=0.088). These average workload figures mask wide variation between practices, with some practices experiencing a substantial reduction in workload and others a large increase. Compared with other English practices in the national GP Patient Survey, in practices using the telephone first approach there was a large (20.0 percentage points, 95% confidence interval 18.2 to 21.9; P<0.001) improvement in length of time to be seen. In contrast, other scores on the GP Patient Survey were slightly more negative. Introduction of the telephone first approach was followed by a small (2.0%) increase in hospital admissions (95% confidence interval 1% to 3%; P=0.006), no initial change in emergency department attendance, but a small (2% per year) decrease in the subsequent rate of rise of emergency department attendance (1% to 3%; P=0.005). There was a small net increase in secondary care costs.Conclusions The telephone first approach shows that many problems in general practice can be dealt with over the phone. The approach does not suit all patients or practices and is not a panacea for meeting demand. There was no evidence to support claims that the approach would, on average, save costs or reduce use of secondary care.

Twitter Demographics

The data shown below were collected from the profiles of 395 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 86 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 86 100%

Demographic breakdown

Readers by professional status Count As %
Unspecified 19 22%
Student > Master 15 17%
Researcher 13 15%
Student > Postgraduate 8 9%
Student > Bachelor 8 9%
Other 23 27%
Readers by discipline Count As %
Medicine and Dentistry 33 38%
Unspecified 24 28%
Nursing and Health Professions 11 13%
Business, Management and Accounting 5 6%
Agricultural and Biological Sciences 4 5%
Other 9 10%

Attention Score in Context

This research output has an Altmetric Attention Score of 334. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 October 2019.
All research outputs
#35,710
of 13,804,624 outputs
Outputs from British Medical Journal
#683
of 45,087 outputs
Outputs of similar age
#1,672
of 273,204 outputs
Outputs of similar age from British Medical Journal
#27
of 767 outputs
Altmetric has tracked 13,804,624 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 45,087 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 30.3. This one has done particularly well, scoring higher than 98% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 273,204 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 767 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 96% of its contemporaries.