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首页> 外文期刊>Journal of medical Internet research >First evaluation of the NHS Direct Online Clinical Enquiry Service: A Nurse-led Web Chat Triage Service for the Public
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First evaluation of the NHS Direct Online Clinical Enquiry Service: A Nurse-led Web Chat Triage Service for the Public

机译：NHS直接在线临床咨询服务的首次评估：由护士主导的面向公众的网络聊天分类服务

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Background: NHS Direct is a telephone triage service used by the UK public to contact a nurse for any kind of health problem. NHS Direct Online (NHSDO) extends NHS Direct, allowing the telephone to be replaced by the Internet, and introducing new opportunities for informing patients about their health. One NHSDO service under development is the Clinical Enquiry Service (CES), which uses Web chat as the communication medium.Objective: To identify the opportunities and possible risks of such a service by exploring its safety, feasibility, and patient perceptions about using Web chat to contact a nurse.Methods: During a six-day pilot performed in an inner-city general practice in Coventry, non-urgent patients attending their GP were asked to test the service. After filling out three Web forms, patients used a simple Web chat application to communicate with trained NHS Direct triage nurses, who responded with appropriate triage advice. All patients were seen by their GP immediately after using the Web chat service. Safety was explored by comparing the nurse triage end point with the GP's recommended end point. In order to check the feasibility of the service, we measured the duration of the chat session. Patient perceptions were measured before and after using the service through a modified Telemedicine Perception Questionnaire (TMPQ) instrument. All patients were observed by a researcher who captured any comments and, if necessary, to assisted with the process.Results: A total of 25 patients (mean age 48 years; 57% female) agreed to participate in the study. An exact match between the nurse and the GP end point was found in 45% (10/22) of cases. In two cases, the CES nurse proposed a less urgent end point than the GP. The median duration of Web chat sessions was 30 minutes, twice the median for NHS Direct telephone calls for 360 patients with similar presenting problems. There was a significant improvement in patients' perception of CES after using the service (mean pre-test TMPQ score 44/60, post-test 49/60; p=0.008 (2-tailed)). Patients volunteered several potential advantages of CES, such as the ability to re-read the answers from the nurse. Patients consider CES a useful addition to regular care, but not a replacement for it.Conclusions: Based on this pilot, we can conclude that CES was sufficiently safe to continue piloting, but in order to make further judgments about safety, more tests with urgent cases should be performed. The Web chat sessions as conducted were too long and therefore too expensive to be sustainable in the NHS. However, the positive reaction from patients and the potential of CES for specific patient groups (the deaf, shy, or socially isolated) encourage us to continue with piloting such innovative communication methods with the public.
机译：背景信息：NHS Direct是英国公众使用的电话分诊服务，用于就任何健康问题与护士联系。 NHS Direct Online（NHSDO）扩展了NHS Direct，允许将电话替换为Internet，并为告知患者健康提供了新的机会。正在开发中的一项NHSDO服务是临床咨询服务（CES），它使用Web聊天作为通信媒介。目的：通过探索该服务的安全性，可行性和患者对使用Web聊天的看法，来确定此类服务的机会和潜在风险。方法：在考文垂市内一个城市普通实践中进行的为期六天的试点中，要求非急诊患者就医。填写了三种Web表格后，患者使用一个简单的Web聊天应用程序与经过培训的NHS Direct分诊护士进行沟通，护士会提供适当的分诊建议。使用网络聊天服务后，所有患者均会立即由其GP诊治。通过比较护士分诊终点与GP推荐的终点来探索安全性。为了检查服务的可行性，我们测量了聊天会话的持续时间。在使用该服务之前和之后，通过改进的远程医疗知觉调查表（TMPQ）仪器来测量患者的知觉。研究人员观察了所有患者，并收集了任何意见，并在必要时进行了辅助研究。结果：共有25名患者（平均年龄48岁;女性占57％）同意参加该研究。在45％（10/22）的病例中，护士和GP终点之间完全匹配。在两种情况下，CES护士提出的紧急终点要比全科医生少。网络聊天会话的平均时间为30分钟，是360名存在类似问题的患者的NHS Direct电话呼叫平均时间的两倍。使用该服务后，患者对CES的认知有了显着改善（平均TMPQ评分为测试​​前44/60，测试后为49/60; p = 0.008（2尾））。患者自愿参加CES的多项潜在优势，例如能够重新阅读护士的答案。患者认为CES是常规护理的有益补充，但不能替代常规护理。结论：根据该试验，我们可以得出结论CES具有足够的安全性可以继续进行试验，但是为了对安全性做出进一步的判断，需要进行更多的紧急检查案件应予以执行。进行的网络聊天会话时间太长，因此太昂贵了，无法在NHS中维持下去。但是，患者的积极反应以及CES对于特定患者群体（聋哑，害羞或社交孤立）的潜力，鼓励我们继续尝试与公众交流这种创新的交流方法。

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