Despite conducting a widespread search for possible data in a variety of sources we were unable to identify any good quality comparative evidence for the use of telephone consultations in place of face to face outpatient appointments after surgery. Although from a limited pool of surgical modalities, data from all four studies suggests that patients were happy to receive routine follow-up care by telephone and in most instances showed some preference to this method compared with an appointment in the outpatient department.
However, the methodological quality of all the identified studies was poor with a moderate to high risk of bias for all the results. In addition, the studies were small, patient satisfaction was measured in a variety of ways and there is little information available on long-term outcomes. The limitations of the included studies have consequences for any sensible extrapolation of the results to other clinical situations.
This research question arose following discussion with surgeons in our local hospital who are routinely replacing face to face outpatient appointments with telephone calls following some surgical procedures. In an environment of increasing cost and demand and a need for ever greater efficiency, it is disappointing that we were able to identify so little comparative research.
In this review, we have taken considerable steps to identify all relevant published and unpublished papers by searching seven electronic databases and hand searching the reference lists of all included papers and many others identified during the search. Although we were only able to include papers published in the English language due to resource constraint, which may have resulted in the omission of some evidence, our searches were not limited to English only and did not identify a significant body of literature in other languages. Very few studies have compared the methods of care and as far as we are aware, this is the first systematic review to specifically address the effectiveness and acceptability of telephone consultation in place of face to face outpatient appointments in patients following uncomplicated surgery.
The authors of a Cochrane Review of telephone consultations in the three months following discharge from hospital identified 33 papers in which telephone follow-up consultations had been evaluated following a wide range of treatments in many patient groups, using a range of comparators and using a variety of outcome measures . In most cases there was no statistically significant difference between telephone and control groups and no meta-analysis was possible. None of the studies identified adverse effects of telephone follow-up. Our review takes a more focused approach than the previous work, addressing explicitly the use of telephone follow up after surgery and compared this with face-to-face hospital based appointments (not home visits). None of the studies included in our review were identified in the Cochrane Review. Furthermore, we have looked at complications related to the surgical operation as this goes to the issue of whether telephone consultations in this context are safe – a necessary pre-requisite for their implementation as routine practice.
Post-surgical consultations may be used for the exchange of a variety of different kinds of information e.g. education, identification of complications, reassurance, management of pain and symptoms. Moreover, the aim for consultations, in most cases, will be discharge from specialist care. It is therefore necessary that the consultation takes careful account of all possible harms and patient concerns. Telephone consultation have been studied in only a small number of conditions and, while they appear to be an innovative use of health service resources, uncertainty remains about their effects and whether these are consistent in different conditions.
There is therefore a need for good quality prospective and, crucially, comparative evaluations of telephone consultations with outpatient appointments in post-surgical care which seek to collect information on all aspects of care. Whilst telephone consultations might be more convenient for patients, there is no indication from the published literature whether this type of after-care has any impact on the frequency of adverse events.