The Effectiveness and coSt effectiveness of TElephone triage of patients requesting same day consultations in gEneral practice: a cluster randomised controlled trial comparing nurse-led and GP-led Management systems

The ESTEEM Trial Update

Recognising the increase in workload in primary care, this trial explores an increasingly popular management model – telephone triage, one means of improving patient access to healthcare by providing rapid access to advice, whilst freeing up opportunities for face-to-face consultation.

Although GP or nurse-led systems are already operating in many practices, there is still uncertainty about the benefits and costs involved and practices considering telephone triage may be unsure which system would work best for them.

The ESTEEM trial will assess the clinical and cost effectiveness of nurse-led computer supported, and GP-led, telephone triage compared to usual care for patients requesting same day consultations in general practice.

 

Primary and Secondary Outcomes

1. Total primary care workload
2. NHS resource use/cost and non-attendance rates in primary care
3. Patient experience of care, safety & health status

 

Progress

Following a pilot study, and three waves of data collection, 42 practices totalling 21,733 patients were identified for the trial from Devon, Bristol & Bath, Coventry & Warwickshire and Norfolk & Suffolk. The first wave of patients in Coventry & Warwickshire was identified for the trial starting in May 2011. Data collection was completed in March 2013 and data analysis is currently underway. Preliminary results should be available from late autumn 2013. A dissemination event for general practices, service users and policy makers is being planned to present the main findings.

 

Warwick University Site Summary

• Total of 11 GP practices across Coventry & Warwickshire PCTs participated
• These were randomised to 3 GP triage, 5 nurse triage and 3 usual care
• In total Warwick recruited 5,450 patients
• Completed data included 4,675 clinician forms, 3,045 returned completed questionnaires and 3,821 case notes reviews

Participating practices have made an important contribution to the largest trial to date to compare different telephone triage systems with ‘usual care’.

 A few Preliminary Figures

Centre	Patient participants identified/triaged	Questionnaires sent	Questionnaires returned	% Qs returned	Patients consenting to notes reviews
EXETER	5,467	5,268	3,136	60%	4,277
NORWICH	5,261	5,101	3,186	62%	4,118
BRISTOL	5,556	5,392	3,127	58%	4,052
WARWICK	5,449	5,299	2,736	52%	3,847
Total	21,733	21,061	12,185	58%	16,294

 

Thank you to all of our practices!

We greatly appreciate the mammoth effort made by our practices to make this trial happen. Thank you to receptionists who have wrangled with complex flow diagrams, administrators and practice managers who rearranged the appointment system for triage, and clinicians who completed a mound of Clinician Forms.

If you would like more information, please visit our website: www.esteemtrial.org.uk

Trial team contact details – Principal Investigator (Warwick) Dr. Tim Holt: tim.holt@phc.ox.ac.uk

Trial Manager Emily Fletcher & Raff Calitri: e.fletcher@exeter.ac.uk; r.calitri@exeter.ac.uk