The Effectiveness and Cost-effectiveness of Medical Advice Given by Telephone for Patients Calling for Primary Care (CMTp)

Assistance Publique - Hôpitaux de Paris

Status: Completed

Conditions: Gastroenteritis Symptoms; Isolated Fever

Treatments: Other: Usual practice; Other: focused Telephonic Medical Advice

Study type: Interventional

Funder types: Other

Identifiers

NCT02286245

K120104

2013-AO1722-43 (Other Identifier)

Details and patient eligibility

About

Telephone medical advice in general practice is expanding. The Cochrane Database concludes in 2008 that there is not enough data about its use regarding out-of-hours general practitioners workload, emergency department visits, cost, safety and patient satisfaction. The aim of this study is to assess the effectiveness of telephone medical advice given by a general practitioner in a call centre for patient presenting isolated fever or gastroenteritis symptoms.

Full description

This is a prospective, open label, cluster randomized trial of 2 880 expected patients who calling a French emergency medical service Dial 15 for fever or gastroenteritis symptoms during out-of-hours periods. All calls will be taken by a general practitioner (GP). Out-of-hours period is defined as 8 PM to 8 AM on weekdays, 1 PM to 8PM on Saturdays in addition to Sundays and holidays.To be exhaustive, we will enrol patients during one year.

In the experimental arm, the GP will implement a protocol of care to each patient call. The protocol includes medical advice, drug prescription by phone and supervisory board. Patients are invited to recall in case of worsening or onset of new symptoms and to get an appointment with their GP during working hours.

In the non-interventional arm, the GP will decide the need of telephone advice with or without drug prescription, home visit by a doctor, emergency department services with or without EMS system.

We will recall every patient at 15+/-4 days.

Enrollment: 2,498 patients

Sex: All

Ages: 1+ year old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Disease:

  • Fever: temperature ≥ 38 ° C
  • Symptoms of gastroenteritis include nausea and / or vomiting and / or diarrhea

• Onset of symptoms for less than 72 hours

• Age ≥ 18 years caller

• Patient age ≥ 1 year

• Affiliation to the French National Health Service

Exclusion criteria

• Pregnancy
• Severity criteria (fever> 41 ° C, disturbance of consciousness, rash, dyspnea, signs of dehydration, chest pain, neurological signs, gastrointestinal bleeding)
• Seeking advice from institutional correspondents (fire brigade, police, airport...)
• Communication difficulties (non-communicating patient, language barrier...)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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2,498 participants in 2 patient groups

1: focused Telephonic Medical Advice

Experimental group

Description:

The physician will implement a protocol of care to each patient call for an isolated fever and/or symptoms of gastroenteritis: medical advice, drug prescription by phone and supervisory board. Patients are invited to recall in case of worsening or onset of new symptoms and to get an appointment with their general practitioner during working hours.

Treatment:

Other: focused Telephonic Medical Advice

2: Usual practice

Active Comparator group

Description:

The physician will decide for the same disease (isolated fever and/or symptoms of gastroenteritis) the need of telephone advice with or without drug prescription, home visit by a doctor, emergency department services with or without EMS system.

Treatment:

Other: Usual practice