Department of Rheumatology, St Helens Hospital, Marshalls Cross Road, St Helens, Merseyside WA93DA, UK
SIR, We read with interest the recent letter by Linton and Meadows [1] outlining their study of patient attitudes to setting up a manned and automated rheumatology telephone helpline service. Their preliminary findings suggested that patients appreciated an open-access, high-quality service. The study analysis comparing pre- and post-introduction questionnaires indicated that patients would prefer to contact the helpline rather than their general practitioner or consultant if they were worried or were experiencing a flare. However, we would be interested to hear whether they compared the satisfaction rate between a manned service and an answerphone service.
The Rheumatology Unit at St Helens and Knowsley NHS trust provides a helpline service to all Rheumatology patients. Until 2 yr ago, this service was manned during office hours by a member of staff, and patients problems were dealt with immediately or passed to the relevant team member.
However, due to a combination of workload, an increasing number of patient calls, the department's open accessibility, the chronic nature of the diseases and the rising number of inappropriate calls it was not possible to continue manning the service. Each member of the multidisciplinary team (nurses, therapists and a metrologist) now has a dedicated answerphone. Patients call one helpline number and are instructed to leave a message on the relevant answerphone. This may require more than one call as the service is not fully automated. Calls are returned as soon as possible, 74% within 24 h.
A prospective study measured the number of calls over a 6-month period, the number of calls to each discipline, the reason for calling and call outcome, e.g. given an appointment with the rheumatology nurse. The department records on average 100 calls per week; 92% are from patients, 3% from community nurses and 1% from general practitioners.
Patients perceptions about the telephone service have also been canvassed via a postal questionnaire. Importantly, patients are also asked how the new service compares with the previous, manned service. Analysis of initial results shows that 76% of patients were very satisfied or satisfied with the multidisciplinary team helpline and the information given, including the response time if a message was left on the answerphone. Of those patients who were able to compare the previous and current services, 46% rated the old service more favourably, 27% felt the service had improved and 27% stated that it had remained unchanged. Not surprisingly, patients do prefer human contact; yet they appear to accept the answerphone, provided the message instructions are clear and the response time efficient.
In our rheumatology department, the number of inappropriate calls has fallen since the start of the answerphone helpline, but so has the total number of calls. This reduction in calls may be a combination of the provision of a patient advice sheet on how to use the service or a clear message directing patients to appropriate destinations, or it may be a sign that many patients ring for support and encouragement as much as for advice, and therefore hang up on hearing the answerphone. This may indicate an unmet patient need, and steps should be taken to make patients aware of how one-to-one support can be accessed.
Despite misgivings, the department believes the answerphone helpline is now an established service. A fully automated touch-tone machine may solve some problems. However, the aim of such a helpline cannot be to provide support and encouragement, but to give advice. To prevent dissatisfaction, patients need to be made aware of the limitations of the helpline service and they should be directed to seek support and encouragement through other mechanisms, such as at clinic appointments or dedicated clinics, or through voluntary support groups, rather than via the telephone.
Notes
Correspondence to: C. Brownsell.
Accepted 28 December 2001
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Department of Rheumatology, Nevill Hall Hospital, Brecon Road, Abergavenny, Monmouthshire NP77EG, UK
SIR, We thank Brownsell and Dawson for the interest shown by their reply to our letter [1]. In response to their specific query, we have not as yet specifically examined the difference in patient satisfaction between a manned and an answerphone helpline service. We share with their Trust the resource pressures described and these, in addition to problems of local geography, require our helpline to be predominantly answerphone-based, though responses are always available within 48 h. It is interesting, though perhaps not surprising, that although the authors found a high level of satisfaction following the introduction of the new service, almost 50% of respondents expressed a preference for a manned service. Although such a service may represent a gold standard from the patients' point of view, issues concerning the efficient use of staff time and existing resource allocation may make it unachievable! We are in the process of undertaking a more thorough review of our helpline operation, which will hopefully provide further information of the type requested by Brownsell and Dawson.
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