Following up outpatients by telephone: pilot study.

Subjects were selected during routine follow up at the rheumatology outpatient clinic. All patients were given a verbal and a written explanation of the aims of the service. An initial detailed clinical assessment and investigations were undertaken to determine patients’ suitability for follow up by telephone. Those considered unsuitable because of clinical circumstances, age, cognitive or hearing impairment, or language problems were excluded. Approval for the study was granted by the hospital management. All but three of the 173 suitable subjects agreed to follow up by telephone at their next review. During the first year of the project 52 patients with rheumatoid arthritis, 27 with soft tissue rheumatism, 22 with degenerative arthritis, 18 with connective tissue disease, 13 with polymyalgia, 9 with ankylosing spondylitis, 4 with gout, and 25 with miscellaneous disorders were followed up by telephone. Patients were telephoned on the appointed date and time (with few exceptions). Their progress was discussed, any changes in the condition or treatment were noted, and they were given the results of any investigations undertaken at their last clinic attendance. Any necessary advice (including changes in treatment) was given on the telephone. Telephone conversations lasted an average of 3.5 (range 1-15) minutes per patient. The main points of the discussion were relayed to the patient’s general practitioner by letter; a copy was sent to the patient to avoid any misunderstanding. No important misunderstandings have occurred to date. Twenty patients could not be contacted by telephone on the appointed date and time. They were either followed up by telephone in the next few days or sent an appointment to attend an outpatient clinic. Decisions made at follow up by telephone were not revised appreciably later, except for two patients with rheumatoid arthritis and two with lupus (one of whom required admission to hospital) who needed earlier clinic review because of flare up. During the first year of the project one of the 170 patients died; this death was not unexpected. Thirty two patients could be discharged after follow up by telephone. A survey of patients’ satisfaction with telephone follow up showed that they were generally in favour (table): it could save time and money, might be more relaxed and less stressful, and obviated problems over transport and waiting. Perceived disadvantages were that telephone follow up was impersonal, patients might feel uncomfortable discussing things over the telephone, the possibility of misunderstanding was greater, and hearing and language problems were more likely.