Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Area of Science:

• Primary Care Management
• Qualitative Health Research
• Health Services Evaluation

Background:

• Telephone triage is a strategy to manage demand for primary care appointments.
• Limited evidence exists on the challenges general practitioner (GP) practices face in implementing telephone triage.
• A qualitative process evaluation was conducted alongside the UK-based ESTEEM cluster randomised trial.

Purpose of the Study:

• To provide insights into the observed effects of the ESTEEM trial from staff and patient perspectives.
• To specify the circumstances under which telephone triage is likely to be successfully implemented.
• To report staff perspectives on the implementation of telephone triage.

Main Methods:

• A qualitative evaluation using staff interviews was conducted.
• Interviews were recruited from eight UK general practices implementing GP-led or nurse-led telephone triage.
• 44 staff members (GPs, nurses, practice managers, administrative staff) were interviewed.

Main Results:

• Staff reported diverse experiences and perceptions of telephone triage implementation and its effects.
• Diversity in experiences was linked to triage organization, staffing models, communication, and role reconfiguration.
• The way triage was organized and communicated significantly impacted staff perceptions.

Conclusions:

• Findings offer insight into how GP practices implemented telephone triage within the ESTEEM trial.
• Successful implementation beyond clinical trials depends on effective communication, preparation, and sustained change.
• Practice culture and staff/patient behavior are key factors shaping the experience of telephone triage.