Effectiveness of telephone consultations for fever or gastroenteritis using a formalised procedure in Emergency Medical Communication Centre: A cluster randomised controlled trial

Objective: To determine the effectiveness of formalised telephone medical advice (fTMA), provided by a physician for fever or gastroenteritis in out-of-hours. Methods: We performed a cluster pragmatic randomised controlled trial and economic evaluation over 12 months. Patients were randomly assigned to either fTMA given by a general practitioner (GP) or usual care. Six French Emergency Medical Communication Centres serving 5.8 million patients participated. We enrolled patients contacting the out-of-hours service for assistance with fever or gastroenteritis. In the experimental arm, fTMA offered reassurance, explanations and advice on therapeutic management, which may include a telephone prescription. The primary endpoint was the percentage of patients with an out-of-hours face-to-face consultation with a GP, or who were admitted to hospital, during the two weeks following their call. Secondary endpoints were the healthcare pathway, clinical outcome and economic analysis. Results: 2,498 callers (1,234 in the intervention group) were included. Patients in the fTMA group were significantly less likely to be admitted to hospital or receive an out-of-hours face-to-face GP consultation at day 15; relative risk -0.36 (95% CI -0.55 to -0.16). There was no significant difference between the two groups regarding ambulance intervention, intensive care admission, mortality or morbidity, improvement of symptoms. During the two-week survey, the average total cost was €91 ± 457 in the fTMA group vs. €150 ± 644 in the usual care group (p<0.01). Conclusions: Introduction of fTMA was associated with a decrease in out-of-hours face-to-face consultations with a GP, or admission to hospital. This procedure is safe, effective and is associated with lower cost compared to usual practice.