Can we Reduce Hospital Attendance Without Compromising Care by the Use of Telephone Consultation

Consultation time in busy respiratory clinics is inevitably limited and attendance is often disruptive to patients' lives; involves time, expense, travel, and waiting; and can have effects upon occupation. Published work suggests that patient satisfaction with telephone consultations is high and this subject has recently been extensively reviewed by one of the study investigators. In respiratory medicine there is United States (US) data to suggest that the regular telephoning of adolescents with asthma by a specialist nurse can reduce unscheduled use of health service resources. In the United Kingdom (UK), a randomised, controlled trial in primary care has shown that, compared to face to face consultations, use of the telephone can enable greater numbers of patients with asthma to be reviewed. Another of the study investigators has undertaken a feasibility study in a general respiratory clinic and has shown the concept of alternating face to face consultation with telephone consultation to be acceptable to over 80% of patients. Over one third were assessed to be suitable in that they did not need to attend the clinic for either physical examination or for investigations. It is therefore proposed to evaluate the feasibility, acceptability, time savings and safety of the use of telephone consultation in 3 respiratory clinics in the Department of Respiratory Medicine at Charing Cross Hospital.