چکیده (انگلیسی):

Background:Telephone triage represents one strategy to manage demand for face-to-face GP appointments in
primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone
triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which
compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost,
patient experience, and safety for patients requesting a same-day GP consultation.
The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the
perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully
implemented. Here we report perspectives of staff.
Methods:The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period
of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices
(4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were
undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers,
13 administrative staff).
Results:Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its
effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was
organised, the staffing models used to support triage, how the introduction of triage was communicated across
practice staff, and by how staff roles were reconfigured as a result of implementing triage.
Conclusion:The findings from the process evaluation offer insight into the range of ways GP practices
participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can
be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone
triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to
implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in
response to the changes made.
Trial registration:Current Controlled Trials ISRCTN20687662. Registered 28 May 2009.