The Effectiveness and Cost-effectiveness of Medical Advice Given by Telephone for Patients Calling for Primary Care
The Effectiveness and Cost-effectiveness of Medical Advice Given by Telephone for Patients Calling for Primary Care
Telephone medical advice in general practice is expanding. The Cochrane Database concludes in
 2008 that there is not enough data about its use regarding out-of-hours general practitioners
 workload, emergency department visits, cost, safety and patient satisfaction. The aim of this
 study is to assess the effectiveness of telephone medical advice given by a general
 practitioner in a call centre for patient presenting isolated fever or gastroenteritis
 symptoms.
This is a prospective, open label, cluster randomized trial of 2 880 expected patients who
 calling a French emergency medical service Dial 15 for fever or gastroenteritis symptoms
 during out-of-hours periods. All calls will be taken by a general practitioner (GP).
 Out-of-hours period is defined as 8 PM to 8 AM on weekdays, 1 PM to 8PM on Saturdays in
 addition to Sundays and holidays.To be exhaustive, we will enrol patients during one year.

 In the experimental arm, the GP will implement a protocol of care to each patient call. The
 protocol includes medical advice, drug prescription by phone and supervisory board. Patients
 are invited to recall in case of worsening or onset of new symptoms and to get an appointment
 with their GP during working hours.

 In the non-interventional arm, the GP will decide the need of telephone advice with or
 without drug prescription, home visit by a doctor, emergency department services with or
 without EMS system.

 We will recall every patient at 15+/-4 days.
Inclusion Criteria:

 -  Disease:

 -  Fever: temperature ≥ 38 ° C

 -  Symptoms of gastroenteritis include nausea and / or vomiting and / or diarrhea

 -  Onset of symptoms for less than 72 hours

 -  Age ≥ 18 years caller

 -  Patient age ≥ 1 year

 -  Affiliation to the French National Health Service

 Exclusion Criteria:

 -  Pregnancy

 -  Severity criteria (fever> 41 ° C, disturbance of consciousness, rash, dyspnea, signs
 of dehydration, chest pain, neurological signs, gastrointestinal bleeding)

 -  Seeking advice from institutional correspondents (fire brigade, police, airport…)

 -  Communication difficulties (non-communicating patient, language barrier...)