Methodological developments in qualitative longitudinal research: the advantages and challenges of regular telephone contact with participants in a qualitative longitudinal interview study.

BACKGROUND: Qualitative longitudinal research is an evolving methodology, particularly within health care research. It facilitates a nuanced understanding of how phenomena change over time and is ripe for innovative approaches. However, methodological reflections which are tailored to health care research are scarce. This article provides a synthesised and practical account of the advantages and challenges of maintaining regular telephone contact between interviews with participants in a qualitative longitudinal study. METHODS: Participants with metastatic colorectal cancer were interviewed at 3 time points over the course of a year. Half the group also received monthly telephone calls to explore the added value and the feasibility of capturing change as close to when it was occurring as possible. RESULTS: The data gathered from the telephone calls added context to the participants' overall narrative and informed subsequent interviews. The telephone calls meant we were able to capture change close to when it happened and there was a more evolved, and involved, relationship between the researcher and the participants who were called on a monthly basis. However, ethical challenges were amplified, boundaries of the participant/researcher relationship questioned, and there was the added analytical burden. CONCLUSIONS: The telephone calls facilitated a more nuanced understanding of the illness experience to emerge, when compared with the interview only group. The findings suggest that intensive telephone contact may be justified if retention is an issue, when the phenomena being studied is unpredictable and when participants feel disempowered or lack control. These are potential issues for research involving participants with long-term illness.

Triaje de las urgencias pediátricas en Atención Primaria en España mediante telefonía móvil. Análisis de un modelo en una zona de salud / Paediatric emergency triage in Spanish primary care using mobile phones. Analysis of a model in a health area

Objetivos. Llevar a cabo un estudio piloto de consulta telefónica en la población pediátrica de un Centro de Salud urbano. Evaluar la consulta telefónica como un instrumento eficaz a la hora de ejercer un triaje previo de los pacientes que demandan atención urgente. Material y métodos. Se efectuó un trabajo piloto en 2 fases. En la primera de ellas se recogieron datos de todas las llamadas recibidas durante 6 meses. En una segunda fase se realizó un estudio de intervención telefónica para analizar en una muestra aleatoria de usuarios el recuerdo de la atención recibida. Se incluyeron como sujetos todos aquellos que solicitaron una demanda telefónica de consulta. En cada uno de ellos se monitorizan variables demográficas, sociosanitarias, epidemiológicas y clínicas. Se procesaron los datos mediante un paquete estadístico SPSS versión 17.0 para Windows. Resultados. En nuestro proyecto telefónico piloto se registraron 439 consultas telefónicas. El 35,1% fueron atendidas por residentes, 36% por pediatras y 28,9% por enfermeras dedicadas a pediatría. La consulta telefónica fue demandada de manera más frecuente en horario de tarde y en fin de semana. Los menores o iguales de 2 años supusieron el 57,9% de las consultas atendidas y no hubo diferencias entre sexos. Los motivos más frecuentes de consulta fueron síntomas gastrointestinales, fiebre y respiratorios. Se comprobó que el consejo fuese resolutivo en el 85,8%, precisando únicamente instrucciones de manejo domiciliario, y solo el 13,3% de los niños precisaron derivación a los servicios de urgencias. Se obtuvo una puntuación media de satisfacción de 9,2. Conclusiones. El proyecto piloto tuvo un alto nivel de satisfacción y capacidad resolutiva, demostrando un ahorro de costes de un 55% respecto a las consultas presenciales con un ahorro de 35,2 euros por consulta telefónica. El modelo de teleconsulta para la atención de las urgencias en Atención Primaria mediante teléfono sería asimilable a un consejo atendido por enfermeras pediátricas entrenadas(AU)

Objectives. To conduct a pilot study of telephone consultation in the paediatric population of an urban health centre. To evaluate the telephone consultation as an effective tool when it comes to exercising prior triage of patients requiring urgent attention. Material and methods. The study was conducted in two phases. In the first, data were collected from all calls received for six months. In a second phase, we conducted a telephone intervention study to analyse what a random sample of users remembered of the care provided. All those who requested a telephone consultation were included in the study. Demographic, social-welfare, epidemiological, and clinical features, of each patient were recorded. Data were processed using a statistical package SPSS version 17.0 for Windows. Results. There were 439 telephone inquiries in our pilot project, of which 35.1% were attended by residents, 36% by paediatricians, and 28.9% by paediatric nurses. There were more telephone calls in the afternoons and on weekends. Patients less than or equal to 2 years accounted for 57.9% of cases handled, and there were no differences between sexes. The most frequent reasons for consultation were gastrointestinal symptoms, fever and respiratory problems. The health problem was resolved in 85.8% of cases, requiring only home care instructions, and only 13.3% of children were referred to emergency services. We obtained a mean score of satisfaction of 9.2. Conclusions. The pilot project had a high level of satisfaction and resolution, demonstrating cost savings by reducing 55% of face to face visits, with a saving of 35.2 euros per telephone consultation. A teleconsultation model for dealing with emergencies in primary care by telephone would be comparable to a practice staffed by trained paediatric nurses(AU)

Interrupciones por llamadas telefónicas en la consulta del médico de familia en 2 centros de salud de Zaragoza / Telephone interruptions in family doctor clinics in two health centres in Saragossa

Objetivos. Analizar las interrupciones por llamadas telefónicas en las consultas de atención primaria, sus motivos y distribución en las jornadas laborales. Diseño. Estudio descriptivo y transversal. Ámbito. El estudio se lleva a cabo en atención primaria, en 2 centros de salud urbanos del sector II de Zaragoza. Metodología. Siete médicos de atención primaria registraron todas las llamadas telefónicas pasadas o no desde el servicio de admisión, a consulta, su origen y características, a lo largo de 5,5 meses. Resultados. La media global de llamadas por día para cada médico ha sido de 1,39 (DE 1,5), siendo de 1,66 (DE 1,53) en San José Norte y de 1,22 (DE 1,46) en San José Centro (p=0,000), con una diferencia entre 0,2 y 0,68 llamadas por consulta y día. La media de llamadas por consulta y día en las consultas de horario de mañana es de 1,37 (DE 1,53) y en las de horario de tarde de 1,44 (DE 1,41), no existiendo una diferencia significativa (p=0,62). Las llamadas originadas por los propios pacientes para hablar directamente con sus médicos constituyen el motivo más frecuente en los horarios de mañana y de tarde (28,5 y 26,5%). La distribución del horario de las llamadas, se centra entre las 10,30 y las 13 h, y entre las 17 y 18 h. Conclusiones. Cuantificar las llamadas telefónicas que se producen durante la consulta del médico de familia, así como conocer su distribución y motivos, permite desarrollar estrategias para aprovechar las ventajas de la llamada telefónica, a la vez que minimizar la interrupción en la consulta (AU)

Objectives. To analyse disruptions due to telephone calls in primary care clinics, their reasons and distribution during the working day. Design. Cross-sectional descriptive study. Setting. The study was conducted in primary care, 2 urban Primary Care Health Centres in Area II of Zaragoza. Methodology. Seven primary care physicians recorded all calls, whether or not they were passed on from the admissions service to clinics, their origin and characteristics, over a period of 5.5 months. Results. The overall mean percentage of calls per day for each doctor was of 1.39 (SD 1.5), being 1.66 (SD 1.53) in San José Norte and 1.22 (SD 1.46) in San José Centro (P=.012), with a difference between 0.2 and 0.68 calls per day per clinic. The mean number of calls per day in the morning clinics and per clinic was 1.37 (SD 1.53) and 1.44 (SD 1.41) in the afternoon clinics, there being a significant difference (P=. 62). Calls originated by the patients themselves to speak directly with their doctors are more frequent in the morning than afternoon hours (28.5% and 26.5%). The distribution of calls is mainly from the 10.30 to 1 p.m., and between the 17:00 and 18:00hours. Conclusions. Quantifying the telephone calls that occur during the family physician clinics, as well as determining their distribution and reasons, allows strategies to be developed to take advantage of the phone calls, as well as minimising disruption in the clinics (AU)

Current ethical issues in child and adolescent psychotherapy.

Core ethical principles for the conduct of psychotherapy with children and adolescents transcend times, trends, and jurisdictions. Advances in technology, variations in state law, and the evolution of federal law should stimulate consideration of how these ethical principles apply to new situations; however, the guiding compass remains the psychotherapist's obligation to create and protect the integrity of the psychotherapeutic space to provide the child or adolescent the freedom to identify, examine, explore, and hopefully resolve the issues that bring one to treatment. Boundaries, privacy, confidentiality, and the patient's autonomy are components of this space. Together, they reflect a basic respect for the patient central to professional conduct and essential to any effective treatment process.

The faceless encounter: ethical dilemmas in telephone nursing.

AIM: This paper aims to present the findings of a study designed to describe ethical dilemmas, in the form of conflicting values, norms and interests, which telenurses experience in their work. BACKGROUND: Telephone nursing is an expanding part of health care. Telephone nurses in Sweden assess care needs, provide advice, support and information, and recommend and coordinate healthcare resources. Lately, ethical demands on healthcare professionals in general have increased. The reasons include new biomedical competence, an ageing population and constrained resources which have made priority setting a primary concern for doctors and nurses. When ethical problems arise, colleagues need open dialogue. Despite this, nurses lack such a dialogue. METHOD: A purposeful sample of 12 female telenurses in Sweden was interviewed twice during 2004 and 2005. The transcribed interviews were analysed thematically. RESULTS: Five themes were found: talking through a third party; discussing personal and sensitive problems over the phone; insufficient resources and the organization of health care; balancing callers' information needs with professional responsibility; and differences in judging the caller's credibility. CONCLUSION: The present study has identified five different themes in which Swedish telenurses experience ethical dilemmas in their work. This shows how ethical dilemmas in various forms are present in telenursing. Questions of autonomy, integrity and prioritizing are particularly highlighted by the participating nurses. Telenurses in Sweden also experience new ethical demands due to a multicultural society. Although several of the identified dilemmas also occur in other areas of nursing we argue that these situations are particularly challenging in telenursing. RELEVANCE TO CLINICAL PRACTICE: The work organization should provide opportunities for ethical competence-building, where ethical dilemmas in telenursing are highlighted and discussed. Such a strategy might lead to decreased moral uncertainty and distress among telenurses, with positive consequences for callers.