Results
Two hundred and fifty-nine patients were included in this study, with a median age of 19.4 years (0.9-91.3 years). The median distance patients resided from <blinded for review> was 15 km (9-179 km) and 2 patients required a telephone interpreter. Details of patient demographics, condition referred, and treatment outcome are presented in Table 1.
The median duration between the date of the first referral and the date of the first telephone appointment with the date of the definitive physical appointment were 317 days (9-1018 days) and 35 days (1-201 days), respectively.
The most common conditions referred to the OHNS clinic were for consideration of tonsillectomy with or without adenoidectomy (44.0%), with the majority of patients undergoing surgical treatment (69.5%). The median number of telephone and physical consultations per patient were 1 (1-3) and 1 (1-2), respectively.
Overall diagnostic accuracy of the initial referrer was 63.3%, with the accuracy of their examination findings being 33.6%. In 58.7% of referrals, examination findings were not stated. The diagnostic accuracy of telephone consultations was 81.9%, with the concordance of recommended treatment plans between telephone and physical consultations being 96.9%.
Residing less than 50km from the hospital, not having concurrent medical conditions and referrals for consideration of tonsillectomy with or without adenoidectomy were associated with significantly better referrer and telephone appointment diagnostic rates (Table 2). Paediatric patients had significantly higher telephone appointment diagnostic rates as well as concordance of recommended treatment plans. Referrals for consideration of grommets, laryngology and otology conditions were associated with significantly poorer referrer and telephone appointment diagnostic rates. More accurate referrer examination findings were observed in paediatric patients, referral for head and neck cancer, and less accurate for laryngology and rhinology conditions.