Feasibility of Telephone Follow-up Visits in Primary Care

The Feasibility of Replacing Follow-up Visits With Telephone Calls in Primary Care: A Randomized Clinical Trial

Doctors frequently speak with their patients over the telephone. Having a visit with a doctor over the telephone rather than face-to-face can be convenient for patients and allow them to save time and money on transportation and missed time from work. However, some patients may prefer seeing the doctor in person. In this study, we will study two groups of patients - some who have their visits with their doctor over the telephone and some who have them face-to-face. Using surveys and interviews, we will study if the groups differ in their satisfaction with their visit with their doctor after participating in the study for 6 months. We will also look at doctor satisfaction with telephone visits, use of clinic resources and if patients received recommended care such as laboratory tests and vaccines during the study period.

Study Overview

• Status: Completed
• Conditions: No Specific Condition
• Intervention / Treatment: Other: Telephone Visit

Detailed Description

This two arm randomized controlled trial will evaluate the effect of telephone follow-up versus standard in-person follow-up (usual care) on patient satisfaction among a sample of 360 primary care patients followed at the Gouverneur Ambulatory Care Practice. All primary care patients will be considered eligible at the outset. Providers will determine patient's study eligibility at the baseline visit based on the ability to safely follow-up the patient's health issue over the telephone in subsequent visits. Eligible patients that are randomized to the telephone follow-up arm will have their next medical visit with their primary care provider via a telephone call. Eligible patients that are randomized to the usual care arm will have a standard in-person clinic visit with their primary care provider. In both study arms, the timing and frequency of follow-up appointments will be determined by the patient's primary care provider. Regardless of group assignment, outcomes will be assessed at the baseline and 6-month study visit.

• Study Type: Interventional
• Enrollment (Actual): 11
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10002
      • Gouverneur TDC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Have a follow-up issue that can be addressed over the phone (as determined by their provider);
• 18 years of age or older;
• Have a working telephone number; and
• Are English, Spanish, Cantonese or Mandarin-speaking.

Exclusion Criteria:

• Patient refusal or are unable to provide informed consent;
• Currently participate in another clinical trial;
• Have significant psychiatric comorbidity or cognitive impairment that would compromise their ability to participate (as determined by their provider); or
• Plan to discontinue care at the Gouverneur Ambulatory Care Practice within the next 6 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: SINGLE_GROUP
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Usual Care; Eligible patients that are randomized to the usual care arm will have a standard in-person clinic visit with their primary care provider.
EXPERIMENTAL: Telephone visit; Eligible patients that are randomized to the telephone follow-up arm will have their next medical visit with their primary care provider via a telephone call.	Other: Telephone Visit; Eligible patients that are randomized to the telephone follow-up arm will have their next medical visit with their primary care provider via a telephone call.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility assessment	Proportion of patients recruited out of the total population and proportion of patients retained at 6 months.	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Provider workload	The number of minutes spent in conversation during the telephone visit	6 months
Provider workload	The total number of scheduled and unscheduled clinic sessions	6 months
Patient Satisfaction	Patient satisfaction assessed with the CG-CAHPS questionnaire. For the purposes of this study we will only use measures related to provider ratings and communication . Semi-structured in-depth interviews will also be conducted with a subsample of patients in the telephone visit arm to elicit their beliefs on the usefulness and appropriateness of telephone visits for their health care needs as well as suggestions for instituting a telephone visit program, and willingness to participate in future telephone visits.	6 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Provider Satisfaction	Provider satisfaction will be assessed with a Likert-type scale that assesses satisfaction with the telephone medicine program after 6 months of participation. A focus group will also be conducted to elicit providers' opinions beliefs regarding the logistical, organizational, and administrative barriers to conducting telephone follow-up visits, usefulness/suitability of telephone visit to address patient concerns, disadvantages and advantages of using telephone visits, opinions on which patients benefit the most from the service, suggestions for improving the process.	6 months
Patient receipt of medical recommendations	Electronic medical records (EMR) will be reviewed to collect data on patient's comorbid conditions, receipt of chronic disease management measures (i.e., blood pressure checks, HbA1c levels), and clinic appointment attendance (i.e., number of visits scheduled with the provider but not attended during the 6-month study period divided by the total number of visits scheduled). Documentation of the receipt of chronic disease management measures (e.g. whether or not patient had recommended blood tests performed) will be used as a proxy for patient adherence.	6 months

Collaborators and Investigators

• Sponsor: NYU Langone Health
• Collaborators: New York City Health and Hospitals Corporation
• Investigators: Principal Investigator: Antoinette Schoenthaler, NYU School of Medicine

Study record dates

Study Major Dates

• Study Start: June 1, 2015
• Primary Completion (ACTUAL): April 1, 2016
• Study Completion (ACTUAL): April 1, 2016

Study Registration Dates

• First Submitted: March 9, 2015
• First Submitted That Met QC Criteria: March 13, 2015
• First Posted (ESTIMATE): March 19, 2015

Study Record Updates

• Last Update Posted (ESTIMATE): April 6, 2016
• Last Update Submitted That Met QC Criteria: April 5, 2016
• Last Verified: April 1, 2016

More Information

Terms related to this study

• Keywords: Telemedicine; Primary Care; Health Services Research
• Other Study ID Numbers: 14-01863