Delivering healthcare at a distance: Exploring the organisation of calls to a health helpline.

Health helplines are integral to contemporary healthcare, offering fast, low-cost, and geographically unrestricted access to health information and advice. Although some health helplines offer support services (e.g., counselling), many function in ways that are similar to physically co-present (i.e., face-to-face) primary care consultations. However, due to the lack of physical presence, there are differences in the way health consultations are routinely managed on the telephone. This article explores some ways in which healthcare is managed at a distance, on a telephone helpline. Data are 196 recorded calls from the helpline, Healthdirect Australia. Using conversation analysis, this paper compares the delivery of healthcare over the telephone with what is known about physically co-present primary care consultations. Through an exploration of the overall structure of these helpline calls, we show how Healthdirect Australia calls are organised in terms of eight distinct phases: call opening, establishment of reason-for-calling, check of caller safety, creation of a confidential patient file, medical information-gathering, health advice, caller survey questions, and call closing. We demonstrate how interactants organise their talk around these phases, with a particular focus on the shift between mandated administrative tasks and traditional medical tasks. Findings from this study suggest that there are systematic differences between the overall structure of health helplines and physically co-present primary care consultations. We demonstrate that the delivery of health information and advice via helplines can be challenging, but that service can be enhanced through continued efforts to inform understanding about how medical encounters routinely unfold in over-the-phone environments.

Lopriore S ，LeCouteur A ，Ekberg S ，Ekberg K ... -  《-》

The league of extraordinary generalists: a qualitative study of professional identity and perceptions of role of GPs working on a national after hours helpline in Australia.

McKenzie R ，Williamson M 《BMC HEALTH SERVICES RESEARCH》

"You'll have to be my eyes and ears": A conversation analytic study of physical examination on a health helpline.

To explore the accomplishment of physical examination on a health helpline. By focusing on the ways in which callers are asked to examine themselves and report information to nurses, we aim to provide insight into how physical examination at a distance is achieved. Physical examination is a routine feature of healthcare encounters. In face-to-face settings, patients are subject to professional scrutiny through talk, touch and observation. Health professionals working on helplines face challenges in assessing signs of illness when they do not have physical access to patients. Conversation analysis was used to explore sequences of interaction between nurses and callers that involved physical examination. Analysis examined how physical examination was routinely accomplished in a helpline environment. Nurses typically guided callers in self-examination by drawing on gross categorisations that required reporting of large-scale characteristics of symptoms (e.g., whether a body part looked "normal"). Physical examination was also regularly accomplished by nurses through two-component speaking turns: a prefacing component that involved instructions about self-examination; followed by a second component that included an information-soliciting question. These practices resulted in callers successfully accomplishing physical examination, despite their lack of professional medical knowledge. This study identifies the communicative practices used by nurses to accomplish physical examination in helpline calls. Such practices involved asking questions that sought general, rather than specific, information and the prefacing of questions with simple instructions on how to undertake self-examination. Previous research indicates that physical examination in telehealth can be challenging, particularly in environments where clinicians need patients to examine themselves. This study identifies how nurses on a helpline manage this challenge. The findings highlight ways in which nurses can recruit patients to undertake tasks that would typically be undertaken by clinicians in physically co-present consultations.

Lopriore S ，LeCouteur A ，Ekberg K ，Ekberg S ... -  《-》

Delivery of telephone-based supportive care to people with cancer: An analysis of cancer helpline operator and cancer nurse communication.

Telephone-based supportive care presents a potentially highly accessible means of addressing unmet supportive care needs for people with cancer. Identification of behaviours that facilitate communication is essential for development of training for telephone-based supportive care. The aim of this study was to describe communication behaviours within supportive care telephone calls in two contexts (1) a telephone outreach intervention and (2) cancer helpline calls, to identify potential areas for further training. 50 recorded calls were analysed using two standardised coding systems: the RIAS and Verona-CoDES-C. Mean call length was 21 min (304 utterances) for nurse-outreach calls and 23 min (355 utterances) for helpline calls. Closed questioning, verbal attentiveness and giving information/counselling were the most common communication behaviours identified. Emotional cues were most commonly responded to through non-explicit back-channelling, exploration of content or provision of reassurance or advice. This study confirmed the need to address the manner in which questions are framed to maximise patient disclosure. Responding to patent emotional cues was highlighted as an area for future training focus. Communication skills training that addresses each of these tasks is likely to improve the effectiveness of telephone-based delivery of supportive care.

Shaw J ，Young J ，Butow P ，Chambers S ，O'Brien L ，Solomon M ... -  《-》

Telephone helplines as a source of support for eating disorders: Service user, carer, and health professional perspectives.

Prior AL ，Woodward D ，Hoefkens T ，Clayton D ，Thirlaway K ，Limbert C ... -  《-》