Thesis (Ph. D.)--University of Wisconsin--Madison, 1970. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--University of Wisconsin--Madison, 1966. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1991. / Also available in print.

Telephone calls have become the primary mode of communication between patients and physicians outside of the office setting. The telephone's importance primarily revolves around its potential to improve physician practices and augment the physician-patient relationship by positively affecting clinical outcomes and overall patient satisfaction. Specific interactions between the physician and patient are termed "encounters"; calls between physician and patient can only be considered "clinical telephone encounters" if they are documented with appropriate elements of a face-to-face encounter, to include history and clinical decision-making. In this thesis, we explore current literature in order to identify how clinical telephone encounters are defined, barriers to gathering data on the telephone, telephone encounter documentation methods, patient and physician perspectives of telephone encounters, telephone encounters in practice, as well as the major areas for improvement in telephone medicine. We utilized traditional systematic search methods in order to identify original research studies and systematic reviews that evaluate telephone communication's role as a medium of healthcare delivery. In reporting on the effectiveness and utilization of telephone care, we principally rely on evidence provided by randomized controlled trials, controlled before-and-after studies, and guidelines published by leading authorities on telephone medicine. The results show a three-function model to frame the telephone interview, which involves determining the problem's nature, developing a therapeutic relationship with the patient, and simultaneously educating the patient while implementing the appropriate treatment plan. Several studies have outlined the importance of documenting clinical telephone encounters, including the highlighting of legal issues pertaining to the practice of medicine, the establishment of clear communication with the primary care physician, and the demonstration of any potential abuses of the system. In practice, studies observing telephone follow-up of cardiac care after either myocardial infarction or surgery demonstrated improved behaviors and patient outcomes, including low-density lipoprotein cholesterol lowering, smoking cessation, improved exercise capacity, and the ability to return to normal activity in a more rapid manner. Telephone encounters may also prove to be appropriate for many acute disorders, respiratory tract infections, and common symptoms. The results also indicate that charging for telephone calls may cause patients to value calls more, changing their views on telephone encounters from favors by the physician to professional treatment. Additionally, the consequences of errors in practicing telephone management have the potential to be severe; from a medicolegal standpoint, telephone patient contacts do not differ from office visits in terms of physician-patient obligations. Finally, training physicians to be competent in telephone medicine is critical, for studies have shown that they tend to consider themselves incompetent at the task. The literature has also shown that providing patient care over the telephone has proven to be an integral part of practicing medicine and requires familiarity (and even mastery) of specific skills. Telephone care has the potential to substitute for office visits under very certain circumstances. Our review also suggests limitations in the overall literature include the consistent quoting of a survey of how many residency programs teach telephone medicine in their curriculums. For example, the number (6%) that is consistently quoted is from a survey taken in 1995. Further studies should be done to determine whether that statistic has improved or changed dramatically in the nearly 20 years that have passed since that survey. Finally, there are many questions regarding telephone medicine's future. It is very likely that the volume of telephone calls between physicians and patients will continue its current growth trends, which necessitates maximal efficacy and efficiency of calls while ensuring cost-effectiveness and reduction. Disease-management strategies, created to empower patients with the ability to self-monitor, may result in more calls regarding the management of chronic illness. Additionally, cost-reduction strategies such as replacing scheduled visits with telephone calls may become the convention.

Konsumenter kan ofta anses vara i underläge i avtalssammanhang och behöver av den anledningen extra skydd. Idag blir många konsumenter uppringda i sina hem eller på sina mobiltelefoner av telefonförsäljare. Många konsumenter tycker att detta är jobbigt och provocerande. Konsumenten kan ofta vara upptagen eller distraherad av annat och det finns många gånger risk för att konsumenten omedvetet tackar ja till ett försäljningserbjudande. Konsumenten kan t.ex. slänga ur sig ett ja i förbifarten, utan att riktigt ha uppfattat vad avtalsvillkoren innebär. Det finns dessutom vissa grupper av konsumenter som kan vara extra utsatta vid avtalssammanhang, speciellt vid försäljning per telefon. Konsumentverket vill av dessa anledningar stärka konsumentskyddet genom att införa ett skriftlighetskrav på muntliga avtal per telefon. Skriftlighetskravet skulle innebära att konsumenten inte blir bunden av det muntliga avtalet förrän denne signerat ett skriftligt avtal i efterhand. Konsumentverket anser att detta skulle kunna öka konsumentens skydd och minska risken för att konsumenter ingår avtal som de egentligen inte menar att ingå.   Som framgått kan telefonförsäljning många gånger ställa till problem för konsumenten. I uppsatsen utreds huruvida det överhuvudtaget är nödvändigt med ökat konsumentskydd vid telefonförsäljning. En statlig utredning har bland annat framfört att införandet av ett skriftlighetskrav skulle kunna stärka konsumentskyddet. I utredningen framhålls det vidare att det finns andra brister i gällande konsumentskydd vid telefonförsäljning. Vi anser att det befintliga konsumentskyddet, med vissa förbättringar i de brister som finns i NIX-Telefon, utgör ett tillräckligt konsumentskydd vid telefonförsäljning.

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Telefonen har under de senaste årtiondena blivit ett viktigt redskap i hälso- och sjukvårdens arbete med människor som söker hjälp och råd för medicinska problem. Telefonlinjer till Sveriges vårdcentraler inrättades allmänt på 1970-talet. En betydande del av sjuksköterskornas arbete på vårdcentral består av telefonrådgivning. Den vårdsökande prioriteras och hänvisas till rätt vårdnivå utifrån den bedömning som görs vid dessa samtal. Syftet med studien är att få kunskap om vad sjuksköterskorna upplever när den vårdsökande inte kan beredas tid trots ett medicinskt behov, då läkartiderna inte räcker till på grund av brist på allmänläkare. Tio sjuksköterskor som arbetar med telefonrådgivning på vårdcentral intervjuades. Studien utfördes med en kvalitativ metod med fenomenologisk ansats. I resultatet framkommer att informanterna har flera olika känslomässiga upplevelser. Informanterna upplever att de inte alltid kan uppfylla det vårdgarantin lovar, men att problemet är organisationsrelaterat och ligger utanför deras egen kontroll. Telefonarbetet kan kännas betungande och tanken på hur det går för den vårdsökande finns ibland kvar efter arbetsdagens slut. Erfarenhet och kunskap anses viktigt för att bättre kunna hantera situationen och göra rätt bedömning. Det kollegiala stödet framhålls som betydelsefullt. Det anses viktigt att noggrant dokumentera givna råd och vilka åtgärder som planerats. / During the past decades the telephone has become an important tool in the healthcare system when people seek help and advice for medical problems. Telephone lines to all healthcare centres in Sweden were established in the 1970´s. A large part of nurses´ work at a healthcare centre consists of giving telephone advice. The callers´ medical needs are assessed and the callers are referred to the proper level of care. The aim of this study is to find out what nurses experience when the caller cannot be given an appointment, despite a medical need for one, because there are insufficient medical appointments available due to a shortage of general practitioners. Ten nurses working with telephone advice at healthcare centre were interviewed. The study was done with a qualitative method using a phenomenological approach. Results indicate that the informants have several different emotional experiences. The informants experience that they cannot always live up to the care guarantee, but that the problem is organizational and beyond their control. Sometimes telephone work feels heavy, and thoughts of how things go for the caller can continue when the work-day is finished. Experience and knowledge are considered important in order to be able to handle the situation better and to make a correct assessment. Support from colleagues is pointed out as meaningful. It is considered important to carefully document the advice given during the telephone call and which measures are planned.

<p>Telefonen har under de senaste årtiondena blivit ett viktigt redskap i hälso- och sjukvårdens arbete med människor som söker hjälp och råd för medicinska problem. Telefonlinjer till Sveriges vårdcentraler inrättades allmänt på 1970-talet. En betydande del av sjuksköterskornas arbete på vårdcentral består av telefonrådgivning. Den vårdsökande prioriteras och hänvisas till rätt vårdnivå utifrån den bedömning som görs vid dessa samtal. Syftet med studien är att få kunskap om vad sjuksköterskorna upplever när den vårdsökande inte kan beredas tid trots ett medicinskt behov, då läkartiderna inte räcker till på grund av brist på allmänläkare. Tio sjuksköterskor som arbetar med telefonrådgivning på vårdcentral intervjuades. Studien utfördes med en kvalitativ metod med fenomenologisk ansats. I resultatet framkommer att informanterna har flera olika känslomässiga upplevelser. Informanterna upplever att de inte alltid kan uppfylla det vårdgarantin lovar, men att problemet är organisationsrelaterat och ligger utanför deras egen kontroll. Telefonarbetet kan kännas betungande och tanken på hur det går för den vårdsökande finns ibland kvar efter arbetsdagens slut. Erfarenhet och kunskap anses viktigt för att bättre kunna hantera situationen och göra rätt bedömning. Det kollegiala stödet framhålls som betydelsefullt. Det anses viktigt att noggrant dokumentera givna råd och vilka åtgärder som planerats.</p> / <p>During the past decades the telephone has become an important tool in the healthcare system when people seek help and advice for medical problems. Telephone lines to all healthcare centres in Sweden were established in the 1970´s. A large part of nurses´ work at a healthcare centre consists of giving telephone advice. The callers´ medical needs are assessed and the callers are referred to the proper level of care. The aim of this study is to find out what nurses experience when the caller cannot be given an appointment, despite a medical need for one, because there are insufficient medical appointments available due to a shortage of general practitioners. Ten nurses working with telephone advice at healthcare centre were interviewed. The study was done with a qualitative method using a phenomenological approach. Results indicate that the informants have several different emotional experiences. The informants experience that they cannot always live up to the care guarantee, but that the problem is organizational and beyond their control. Sometimes telephone work feels heavy, and thoughts of how things go for the caller can continue when the work-day is finished. Experience and knowledge are considered important in order to be able to handle the situation better and to make a correct assessment. Support from colleagues is pointed out as meaningful. It is considered important to carefully document the advice given during the telephone call and which measures are planned.</p>