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Background: Telephone triage and advice services (TTAS) are increasingly being implemented around the world. These services allow people to speak to a nurse or general practitioner over the telephone and receive assessment and healthcare advice. There is an existing body of research on the topic of TTAS, however the diffuseness of the evidence base makes it difficult to identify key lessons that are consistent across the literature. Systematic reviews represent the highest level of evidence synthesis. We aimed to undertake an overview of such reviews to determine the scope, consistency and generalisability of findings in relation to the governance, safety and quality of TTAS.Methods: We searched PubMed, MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library for English language systematic reviews focused on key governance, quality and safety findings related to telephone based triage and advice services, published since 1990. The search was undertaken by three researchers who reached consensus on all included systematic reviews. An appraisal of the methodological quality of the systematic reviews was independently undertaken by two researchers using A Measurement Tool to Assess Systematic Reviews.Results: Ten systematic reviews from a potential 291 results were selected for inclusion. TTAS was examined either alone, or as part of a primary care service model or intervention designed to improve primary care. Evidence of TTAS performance was reported across nine key indicators - access, appropriateness, compliance, patient satisfaction, cost, safety, health service utilisation, physician workload and clinical outcomes. Patient satisfaction with TTAS was generally high and there is some consistency of evidence of the ability of TTAS to reduce clinical workload. Measures of the safety of TTAS tended to show that there is no major difference between TTAS and traditional care.Conclusions: Taken as a whole, current evidence does not provide definitive answers to questions about the quality of care provided, access and equity of the service, its costs and outcomes. The available evidence also suggests that there are many interactional factors (e.g., relationship with other health service providers) which can impact on measures of performance, and also affect the external validity of the research findings. [ABSTRACT FROM AUTHOR]

Background: Despite the importance of pathology testing in diagnosis and disease monitoring, there is little in-depth research about pathology test ordering in general practice and how it impacts patient outcomes. This is in part due to the limited availability of high-quality data. With the now-widespread use of electronic software in general practice comes the potential for electronic patient data to be used for research leading to better understanding of general practice activities, including pathology testing.Objectives: This study aimed to examine the usefulness of electronic general practice pathology data to: (1) identify patients' characteristics, (2) monitor quality of care, (3) evaluate intervention effects, (4) identify variations in patient care, and (5) measure patient outcomes. An exemplar study evaluating kidney function testing in type 2 diabetes mellitus (type 2 diabetes) compared to guidelines was used to demonstrate the value of pathology data.Materials and Methods: De-identified electronic data from approximately 200 general practices in Victoria were extracted using Outcome Health's Population Level Analysis & Reporting (POLAR) Aurora research platform. Our study population included patients ≥18 diagnosed with type 2 diabetes before July 2016. Data from July 2016 to June 2018 were used to i) determine frequency of kidney function tests (KFT), and ii) identify whether antihypertensive medications were prescribed for abnormal KFT results.Results: There were 20,514 active patients with type 2 diabetes identified from the data. The age and gender standardised estimate of diabetes prevalence was 4.9%, consistent with Australian estimates (5.2%). Sociodemographic features of prevalence, including higher prevalence in older males, were also consistent with previous Australian estimates. Kidney function testing was performed annually, as recommended by guidelines, in 75.7% of patients, with higher annual testing observed in patients managed under general practice incentive programs (80.1%) than those who were not (72.2%). Antihypertensive medications were prescribed as recommended in 77.4% of patients with suspected microalbuminuria or macroalbuminuria based on KFT results.Discussion: Evaluations using data from diabetes patients in this study illustrate the value of electronic data for identifying patients with the condition of interest (e.g. type 2 diabetes) along with sociodemographic characteristics. This allows for the ability to undertake analyses on pathology testing factors and the identification of variation compared to guidelines, which has a potential to ensure quality of care. Its potential to identify associations with incentive programs further demonstrates the advantages of the data's longitudinal nature. These include the ability to assess temporal order and time interval of tests as a marker of quality of monitoring and evaluate intervention effects on a cohort over time. Finally, analyses on antihypertensive medication prescribing in patients with suspected micro/macroalbuminuria exemplified the electronic data's usefulness in monitoring patient outcomes, such as appropriate prescribing based on pathology test results.Conclusions: Electronic general practice data is an important resource which can provide valuable insights about the quality use of pathology. There are clear benefits to patients for better monitoring, and consequent better outcomes, and to inform policymakers about the best ways to channel resources to enhance the quality of care. [ABSTRACT FROM AUTHOR]