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Cooper IR, Schmaus A, Whitten TA, Bakal JA, Kurji F, Watt D, Lang E. Descriptive analysis and evaluation of Health Link referrals to the emergency department before and during the COVID-19 pandemic. Intern Emerg Med 2024; 19:1129-1137. [PMID: 38386095 DOI: 10.1007/s11739-023-03527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/27/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In Alberta, Health Link (HL) provides a 24-h, nurse-staffed, phone resource to the public for health-care advice. HL directs callers to either seek care in the emergency department (ED), with a primary care provider or provide self-care at home. This work aims to describe HL ED referrals prior to and during the COVID-19 pandemic. METHODS Data from January 1, 2018-December 31, 2019, and July 1, 2020-June 30, 2022, were selected. HL calls were categorized as likely appropriate if the patient was referred and presented to the ED within 24 h and had a Canadian Triage and Acuity Scale (CTAS) of 1-3; or a CTAS of 4-5 and the patient was admitted, specialist consulted, or diagnostic imaging or laboratory tests were completed. The primary outcome was the percentage of likely appropriate referrals among all HL ED referrals. RESULTS In the 2018-2019 and 2020-2022 samples, respectively, there were 845,372 and 832,730 calls. Of the 211,723 and 213,486 ED referrals, only 140,614 (66.4%) and 143,322 (67.1%) presented to an ED. Of these, 84.3 and 86.7 per 100 patient visits were categorized as likely appropriate referrals. Health Link referrals account for 3.2% and 3.8% of all ED visits. IMPACT HL referrals to the ED represent only a small percentage of all ED visits. Based on our definition, most referrals by HL are likely appropriate. The COVID-19 pandemic does not appear to have altered the rates of calls to HL, the number of HL calls referred to the ED, nor the likely appropriateness of those referrals.
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Affiliation(s)
- Ian R Cooper
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Andrew Schmaus
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tara A Whitten
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Jeffery A Bakal
- Alberta Health Services, Edmonton, AB, Canada
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
- Provincial Research Data Services, Calgary, AB, Canada
| | - Fayaz Kurji
- Alberta Health Services, Edmonton, AB, Canada
| | - Denise Watt
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Eddy Lang
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Alberta Health Services, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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Azimzadeh S, Azami-Aghdash S, Tabrizi JS, Gholipour K. Reforms and innovations in primary health care in different countries: scoping review. Prim Health Care Res Dev 2024; 25:e22. [PMID: 38651337 DOI: 10.1017/s1463423623000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends focusing on primary health care (PHC) as the first strategy of countries to achieve the improvement of the health level of communities and has emphasized it again in 2021. Therefore, we intend to take a different look at the PHC system with reform, innovation, and initiative by using the experiences of leading countries and identify practical and evidence-based solutions to achieve greater health. METHODS This is a scoping review study that has identified innovations and reforms related to PHC since the beginning of 2000 to the end of 2022. In this study, Scopus, Web Of Science, and PubMed databases have been searched using appropriate keywords. This study is done in six steps using Arkesy and O'Malley framework. In this study, the framework of six building blocks of WHO was used to summarize and report the findings. RESULTS By searching in different databases, we identified 39426 studies related to reforms in primary care, and after the screening process, 106 studies were analyzed. Our findings were classified and reported into 9 categories (aims, stewardship/leadership, financing & payment, service delivery, health workforce, information, outcomes, policies/considerations, and limitations). CONCLUSION The necessity and importance of strengthening PHC is obvious to everyone due to its great consequences, which requires a lot of will, effort, and coordination at the macro-level of the country, various organizations, and health teams, as well as the participation of people and society.
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Affiliation(s)
- Solmaz Azimzadeh
- Health Policy, Department of Health Policy & Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Health Policy, Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Health Services Management, Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Duncan R, Stewart K, Scheuermeyer FX, Abu-Laban RB, Ho K, Lavallee D, Christenson J, Wood N, Bryan S, Hedden L. Concordance between 8-1-1 HealthLink BC Emergency iDoctor-in-assistance (HEiDi) virtual physician advice and subsequent health service utilization for callers to a nurse-managed provincial health information telephone service. BMC Health Serv Res 2023; 23:1031. [PMID: 37759257 PMCID: PMC10523598 DOI: 10.1186/s12913-023-09821-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND British Columbia 8-1-1 callers who are advised by a nurse to seek urgent medical care can be referred to virtual physicians (VPs) for supplemental assessment and advice. Prior research indicates callers' subsequent health service use may diverge from VP advice. We sought to 1) estimate concordance between VP advice and subsequent health service use, and 2) identify factors associated with concordance to understand potential drivers of discordant cases. METHODS We linked relevant provincial administrative databases to obtain inpatient, outpatient, and emergency service use by callers. We developed operational definitions of concordance collaboratively with researcher, patient, VP, and management perspectives. We used Kaplan-Meier curves to describe health service use post-VP consultation and Cox regression to estimate the association of caller factors (rurality, demography, attachment to primary care) and call factors (reason, triage level, time of day) with concordance as hazard ratios. RESULTS We analyzed 17,188 calls from November 16, 2020 to April 30, 2021. Callers advised to attend an emergency department (ED) immediately were the most concordant (73%) while concordance was lowest for those advised to seek Family Physician (FP) care either immediately (41%) or within 7 days (47%). Callers unattached to FPs were less likely to schedule an FP visit (hazard ratio = 0.76 [95%CI: 0.68-0.85]). Rural callers were less likely to attend an ED within 48 h when advised to go immediately (0.53 [95%CI:0.46-0.61]) compared to urban callers. Rural callers advised to see an FP, either immediately (1.28 [95%CI:1.01-1.62]) or within 7 days (1.23 [95%CI: 1.11-1.37]), were more likely to do so than urban callers. INTERPRETATION Concordance between VP advice and subsequent caller health service use varies substantially by category of advice and caller rurality. Concordance with advice to "Go to ED" is high overall but to access primary care is below 50%, suggesting potential issues with timely access to FP care. Future research from a patient/caller centered perspective may reveal additional barriers and facilitators to concordance.
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Affiliation(s)
- Ross Duncan
- Michael Smith Health Research British Columbia, Vancouver, Canada.
- BC Emergency Medicine Network, Vancouver, Canada.
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Kurtis Stewart
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Frank X Scheuermeyer
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Riyad B Abu-Laban
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kendall Ho
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Danielle Lavallee
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jim Christenson
- BC Emergency Medicine Network, Vancouver, Canada
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Nancy Wood
- BC Emergency Medicine Network, Vancouver, Canada
| | - Stirling Bryan
- Michael Smith Health Research British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Lindsay Hedden
- Michael Smith Health Research British Columbia, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Ho K, Abu-Laban RB, Stewart K, Duncan R, Scheuermeyer FX, Hedden L, Lauscher HN, Sundhu S, Chadha R, Christenson J, Grafstein E, Lavallee DC, Purssell R, Tallon JM, Wood N, Bryan S. Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study. CMAJ Open 2023; 11:E459-E465. [PMID: 37220956 DOI: 10.9778/cmajo.20220196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND British Columbia's 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician. METHODS We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes. RESULTS We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a "try home treatment" disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died. INTERPRETATION This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits.
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Affiliation(s)
- Kendall Ho
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Riyad B Abu-Laban
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Kurtis Stewart
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Ross Duncan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Frank X Scheuermeyer
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Lindsay Hedden
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Helen Novak Lauscher
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Sandra Sundhu
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Rina Chadha
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Jim Christenson
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Eric Grafstein
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Danielle C Lavallee
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Roy Purssell
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - John M Tallon
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Nancy Wood
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
| | - Stirling Bryan
- Department of Emergency Medicine (Ho, Abu-Laban, Stewart, Duncan, Scheuermeyer, Novak Lauscher, Chadha, Christenson, Grafstein, Purssell, Tallon), Faculty of Medicine, The University of British Columbia; BC Emergency Medicine Network (Ho, Abu-Laban, Duncan, Scheuermeyer, Christenson, Grafstein, Wood); Michael Smith Health Research BC (Duncan, Hedden, Lavallee, Bryan), Vancouver, BC; Faculty of Health Sciences (Hedden), Simon Fraser University, Burnaby, BC; HealthLink BC (Sundhu); Centre for Health Evaluation and Outcomes Sciences (Christenson), Providence Research Institute; School of Population and Public Health (Lavallee, Bryan), The University of British Columbia, Vancouver, BC
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Zwank MD, Finn ZS, Barnes ML, Adams NR. Severity of diagnosis among patients with chest pain presenting to the emergency department after calling a nurse line. Am J Emerg Med 2021; 44:121-123. [PMID: 33588252 DOI: 10.1016/j.ajem.2021.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A Nurse Line (NL) is a resource that is commonly used by patients and hospitals to assist in the triage of patient medical complaints. We sought to determine whether patients with chief complaint of chest pain who presented to the ED after calling a NL were different from patients who presented directly to the ED. The primary aim was to test for differences in the severity of the causes of chest pain between the two groups. METHODS This was a retrospective case-control chart review study. Data collected included demographic data, comorbidities, ED orders, ED interventions, patient primary diagnosis and disposition. RESULTS 350 patients were included in the analysis: 175 patients called the NL and 175 age/sex matched patients did not call the NL. The mean age was 58.3 (SD 16.4; range 19.1-93.3) and 53.7% of patients were female. Race was similar between the groups. Patients were more likely to go directly to the ED without calling a NL if they had comorbidities. Among the total cohort, 36 patients were deemed to have a serious diagnosis related to the pain; this did not differ between groups (16 NL, 20 non-NL; OR = 1.11 95%CI 0.55-2.23). There were no differences of ED work-up or hospital admission (50 NL, 67 non-NL; OR = 0.85 95%CI 0.51-1.42) between the groups. CONCLUSION NL call was not associated with differences in severity of diagnosis, work-up, hospital admission or patient demographics. Patients who presented to the ED with chest pain without calling a NL had more comorbidities.
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Affiliation(s)
| | - Zachary S Finn
- Regions Hospital, Saint Paul, MN, United States of America
| | | | - Nell R Adams
- Regions Hospital, Saint Paul, MN, United States of America
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Exploring the role of nurses in after-hours telephone services in regional areas; A scoping review. PLoS One 2020; 15:e0237306. [PMID: 32834017 PMCID: PMC7446909 DOI: 10.1371/journal.pone.0237306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 07/11/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The management of patients who need chronic and complex care is a focus of attention internationally, brought about by an increase in chronic conditions, requiring significantly more care over longer periods of time. The increase in chronic conditions has placed pressure on health services, financially and physically, bringing about changes in the way care is delivered, with hospital avoidance and home-based care encouraged. In this environment, nurses play an important role in co-ordinating care across services. This review formed one part of a funded project that explored the nurse navigator role within a proposed 24-hour telephone-call service in one regional area that has a diverse population in terms of cultural identity and geographical location in relation to service access. AIM The review reports on the extant literature on the nurse's role in the provision of afterhours telephone services for patients with chronic and complex conditions. The specific aim was to explore the effectiveness of services for patients in geographically isolated locations. METHODS The methodological approach to the review followed the Preferred Reporting System for Meta-Analyses (PRISMA) guidelines. A thematic analysis was used to identify themes with chronic care models underpinning analysis. RESULTS Three themes were identified; nurse-led decision making; consumer profile; and program outcomes. Each theme was divided into two sub-themes. The two sub-themes for decision making were: the experience of the staff who provided the service and the tool or protocol used. The two sub-themes for consumers profile were; the geographic/demographic identity of the consumers, and consumer satisfaction. The final theme of outcomes describes how the effectiveness of the service is measured, broken into two sub-themes: the economic/workforce outcomes and the consumer outcomes. DISCUSSION The provision of an after-hours telephone service, in whatever model used should align with a Chronic Care Model. In this way, after-hours telephone services provided by experienced nurses, supported by ongoing professional development and relevant protocols, form part of the ongoing improvement for chronic and complex care management as a health priority.
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McAlister FA, Tonelli M, Wiebe N, Lin M, Svenson LW, Dean S. The ecology of medical care for adults in Alberta, 2002/03 to 2016/17: a retrospective cohort study. CMAJ Open 2020; 8:E169-E177. [PMID: 32184280 PMCID: PMC7082108 DOI: 10.9778/cmajo.20190188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND If we are to improve the patient experience, knowing where and with whom people receive professional health advice and treatment (the ecology of medical care) is the first step. We designed this study to define the ecology of medical care in Alberta and to examine whether province-wide implementation of 5 policy changes between 2003 and 2012 changed patterns of care among adults in the province. METHODS This was a retrospective cohort study of adults (age ≥ 18 yr) in Alberta using routinely collected data from 6 linked administrative health databases, the 2016 Canadian Community Health Survey and the Alberta Health Link teletriage system. We collected data on all encounters with pharmacists, primary care physicians, specialists, emergency departments and hospitals in 2002/03, 2009/10 and 2016/17. RESULTS Between 2002/03 and 2016/17, the community-dwelling adult population of Alberta increased from 2.66 million to 3.84 million; the median age increased from 41 to 43 years, and the proportion with at least 1 ambulatory-care-sensitive condition increased from 20.6% to 27.8%. The proportion who saw a primary care physician decreased significantly (from 70.8% to 68.2%, p < 0.001), as did the proportion who visited an emergency department (from 20.6% to 19.2%, p < 0.001); the declines were seen in all subgroups examined. The proportion who saw a specialist as an outpatient increased from 31.9% to 33.2% (p < 0.001), and the proportion who received at least 1 medication dispensation increased from 54.9% to 60.2% (p < 0.001). The proportion admitted to an acute care hospital (5.6%-6.5%) or academic hospital (1.2%) was relatively stable over time. INTERPRETATION Despite implementation of 5 system-wide changes designed to affect the delivery of primary and specialty medical care as well as the use of pharmacist and nursing services in Alberta, patterns of health care delivery changed little between 2002/03 and 2016/17. Rather than searching for a policy "magic bullet," health care planners may be better served by focusing on upscaling and implementing interventions proven to be efficacious.
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Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta.
| | - Marcello Tonelli
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Natasha Wiebe
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Meng Lin
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Lawrence W Svenson
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
| | - Stafford Dean
- Division of General Internal Medicine (McAlister), Alberta SPOR Support Unit Data Platform (McAlister, Lin) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Lin), University of Alberta, Edmonton, Alta.; Departments of Medicine (Tonelli, Svenson) and Community Health Sciences (Tonelli, Svenson), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Division of Nephrology (Wiebe), Department of Medicine, University of Alberta; Alberta Health (Svenson); Division of Preventive Medicine (Svenson) and School of Public Health (Svenson), University of Alberta, Edmonton, Alta.; Data Integration Measurement and Reporting (Dean), Alberta Health Services, Calgary, Alta
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Age and Sex Differences in the Use of Emergency Telephone Consultation Services in Saitama, Japan: A Population-Based Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010185. [PMID: 31888058 PMCID: PMC6982294 DOI: 10.3390/ijerph17010185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/21/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
The frequency of use of emergency telephone consultation (ETC) services, which is a telephone triage system in Japan, was explored to determine age- and sex-related trends on symptoms/events among Japanese adults. Data were obtained from records of the initial year of ETC services in Saitama Prefecture (from October 2014 to September 2015). Residents who used the ETC services were divided into four age groups (20–39, 40–64, 65–74, and ≥75 years old). The number of calls per 1000 persons (call rate, CR) was compared between the groups. The annual CR for the top 10 symptoms/events were assessed. The annual CR was 2.6/1000 persons. The annual CR was significantly higher for women (2.9) than for men (2.3) (p < 0.05). ETC use was the highest in the 20–39 age group for both sexes (3.3 and 4.4 in men and women, respectively). All groups had fever, abdominal pain, and nausea/vomiting in common. In older adults, the frequency of events such as bruises and head injury was high. Women and younger adults tended to use ETC services. There were similarities and differences in symptoms/events among the groups, which should be recognized by call centers to help foster call center staff.
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Siddiqui N, Greenfield D, Lawler A. Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service. Int J Health Plann Manage 2019; 35:735-745. [PMID: 31803956 DOI: 10.1002/hpm.2934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/24/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
Understanding the influence of a telephone triage advice service (TTAS) on patients seeking care is critical to realize enhancements in patient care, functioning of emergency departments (EDs), and effectiveness of the health system. This study addresses the question: what influence does a TTAS have on a patient's attendance at an ED and the wider health system? Records from 2016 to 2017 of 12,741 calls from a national TTAS were linked to 72,577 ED presentations to a hospital in regional Australia, retrospectively. Matching criteria included patient within the hospital's statistical local area code, age, gender, and ED attendance within 8 hours of TTAS call. Five statistical analyses of the data were conducted. There were 2857 matches. TTAS patients accessing the ED had a slightly higher proportion of women and a greater proportion of children under 4 years than usual. When TTAS confirmed callers' inclination for ED care, however only up to 69% subsequently attended the ED. When TTAS redirected others initially less inclined to more urgent care, up to 62% attended the ED. TTAS empowers vulnerable patients to access appropriate and timely services and promotes clinical and functional integration of care. Improvements of TTAS can come through investigation of callers' compliance factors.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - David Greenfield
- Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Hobart, Australia
| | - Anthony Lawler
- Department of Health Tasmania, University of Tasmania, Hobart, Australia
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Tran DT, Gibson A, Randall D, Havard A, Byrne M, Robinson M, Lawler A, Jorm LR. Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study. BMC Health Serv Res 2017; 17:512. [PMID: 28764695 PMCID: PMC5539620 DOI: 10.1186/s12913-017-2458-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Background Middle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call. Methods Records of calls to the Australian healthdirect helpline (July 2008–December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice “Attend ED immediately”; “See a doctor (immediately, within 4 hours, or within 24 hours)”; “Self-care”; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics. Results This study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices “Attend ED immediately”, “See a doctor” and “Self-care” were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice “Attend ED immediately” was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice “See a doctor” was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas, when another person made the call on the patient’s behalf, and when the original intention was to seek care from an ED or a doctor. It was lower among patients in rural and remote areas and those taking five medications or more. Patients aged ≥65 years were less likely to comply with the advice “Self-care”. The rates of self-referral to ED within 24 h were greater in patients from disadvantaged areas, among calls made after-hours or by another person, and when the original intention was to attend ED. Patients who were given a self-care or low-urgency care advice, whose calls concerned bleeding, cardiac, gastrointestinal, head and facial injury symptoms, were more likely to self-refer to ED. Conclusions Compliance with telephone triage advice among middle-age and older patients varied substantially according to both patient- and call-related factors. Knowledge about the patients who are less likely to comply with telephone triage advice, and about characteristics of calls that may influence compliance, will assist in refining patient triage protocols and referral pathways, training staff and tailoring service design and delivery to achieve optimal patient compliance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2458-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duong Thuy Tran
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia.
| | - Amy Gibson
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Alys Havard
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
| | - Mary Byrne
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Maureen Robinson
- Healthdirect Australia, 133 Castlereagh Street, Sydney, NSW, 2000, Australia
| | - Anthony Lawler
- School of Medicine, University of Tasmania and Healthdirect Australia, Department of Health and Human Services, Level 2, 22 Elizabeth Street, Hobart, TAS, 7000, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health-Faculty of Medicine, UNSW Sydney (The University of New South Wales), Sydney, NSW, 2052, Australia
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Gibson A, Randall D, Tran DT, Byrne M, Lawler A, Havard A, Robinson M, Jorm LR. Emergency Department Attendance after Telephone Triage: A Population-Based Data Linkage Study. Health Serv Res 2017; 53:1137-1162. [PMID: 28369871 DOI: 10.1111/1475-6773.12692] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To investigate compliance with telephone helpline advice to attend an emergency department (ED) and the acuity of patients who presented to ED following a call. DATA SOURCES/COLLECTION METHODS In New South Wales (NSW), Australia, 2009-2012, all (1.04 million) calls to a telephone triage service, ED presentations, hospital admissions and death registrations, linked using probabilistic data linkage. STUDY DESIGN Population-based, observational cohort study measuring ED presentations within 24 hours of a call in patients (1) with dispositions to attend ED (compliance) and (2) low-urgency dispositions (self-referral), triage categories on ED presentation. PRINCIPAL FINDINGS A total of 66.5 percent of patients were compliant with dispositions to attend an ED. A total of 6.2 percent of patients with low-urgency dispositions self-referred to the ED within 24 hours. After age adjustment, healthdirect compliant patients were significantly less likely (7.8 percent) to receive the least urgent ED triage category compared to the general NSW ED population (16.9 percent). CONCLUSIONS This large population-based data linkage study provides precise estimates of ED attendance following calls to a telephone triage service and details the predictors of ED attendance. Patients who attend an ED compliant with a healthdirect helpline disposition are significantly less likely than the general ED population to receive the lowest urgency triage category on arrival.
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Affiliation(s)
- Amy Gibson
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Deborah Randall
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Duong T Tran
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Mary Byrne
- Healthdirect Australia, Sydney, NSW, Australia
| | - Anthony Lawler
- Department of Health and Human Services, University of Tasmania and Healthdirect Australia, Hobart, Tasmania, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
| | - Maureen Robinson
- Healthdirect Australia, Clinical Governance, Sydney, NSW, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW, Sydney, NSW, Australia
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McKenzie R, Dunt D, Yates A. Patient intention and self-reported compliance in relation to emergency department attendance after using an after hours GP helpline. Emerg Med Australas 2016; 28:538-43. [DOI: 10.1111/1742-6723.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/07/2016] [Accepted: 05/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Rosemary McKenzie
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - David Dunt
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Allison Yates
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (1) demand – there is little empirical evidence to explain increases in demand for urgent care; (2) telephone triage – overall, these services provide appropriate and safe decision-making with high patient satisfaction, but the required clinical skill mix and effectiveness in a system is unclear; (3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough there is a large body of evidence on relevant interventions, much of it is weak, with only very small numbers of randomised controlled trials identified. Evidence is dominated by single-site studies, many of which were uncontrolled.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for more detailed understanding and mapping of the characteristics of demand to inform service planning; (2) assessment of the current state of urgent care network development and evaluation of the effectiveness of different models; and (3) expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Calitri R, Warren FC, Wheeler B, Chaplin K, Fletcher E, Murdoch J, Richards S, Taylor RS, Varley A, Campbell J. Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care. Health Place 2015; 34:92-6. [DOI: 10.1016/j.healthplace.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 04/15/2015] [Accepted: 04/17/2015] [Indexed: 11/28/2022]
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Metcalfe A, Sibbald B, Lowry RB, Tough S, Bernier FP. Validation of congenital anomaly coding in Canada's administrative databases compared with a congenital anomaly registry. ACTA ACUST UNITED AC 2013; 100:59-66. [PMID: 24307632 DOI: 10.1002/bdra.23206] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/17/2013] [Accepted: 10/19/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Congenital anomaly (CA) surveillance provides epidemiologic data that are necessary for health planning. Approaches to CA surveillance vary; however, an increasing number of jurisdictions rely on administrative health databases for case ascertainment. This study aimed to assess the validity of CA coding in three administrative databases compared with a CA registry. METHODS A cohort of 5862 live and stillborn infants from Calgary Alberta Canada was created through linking 12 clinical and administrative databases. Diagnostic codes for all health care contacts (hospitalizations, emergency room visits, out-patient physician visits) in the first 3 months of life were examined for relevant International Classification of Disease codes. Sensitivity, positive predictive values, and kappa coefficients were calculated, and data from the Alberta Congenital Anomalies Surveillance System was used as the reference standard. RESULTS The ability of administrative data to accurately ascertain CAs varied by data source and the specificity of the diagnosis. Consistently, hospitalization data out-performed other administrative data sources in terms of sensitivity, positive predictive values, and kappa. Kappa scores for CAs easily visible at birth ranged from moderate (0.62 for emergency room visits and 0.65 for out-patient physician claims) to good (0.83 for hospitalization data) depending on the data source. CONCLUSION The validity of CA coding in administrative databases compared with a CA registry varies by database used and by CA studied. This has important implications for national surveillance efforts. Condition-specific validity should be assessed locally before use of these data sources for research or planning purposes.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, British Columbia, Canada
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Metcalfe A, Grabowska K, Weller C, Tough SC. Impact of prenatal care provider on the use of ancillary health services during pregnancy. BMC Pregnancy Childbirth 2013; 13:62. [PMID: 23497179 PMCID: PMC3599935 DOI: 10.1186/1471-2393-13-62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/01/2013] [Indexed: 11/15/2022] Open
Abstract
Background Recent declines in the provision of prenatal care by family physicians and the integration of midwives into the Canadian health care system have led to a shift in the pattern of prenatal care provision; however it is unknown if this also impacts use of other health services during pregnancy. This study aimed to assess the impact of the type of prenatal care provider on the self-reported use of ancillary services during pregnancy. Methods Data for this study was obtained from the All Our Babies study, a community-based prospective cohort study of women’s experiences during pregnancy and the post-partum period. Chi-square tests and logistic regression were used to assess the association between type of prenatal care provider and use of ancillary health services in pregnancy. Results During pregnancy, 85.8% of women reported accessing ancillary health services. Compared to women who received prenatal care from a family physician, women who saw a midwife were less likely to call a nurse telephone advice line (OR = 0.30, 95% CI: 0.18-0.50) and visit the emergency department (OR = 0.47, 95% CI: 0.24-0.89), but were more likely receive chiropractic care (OR = 4.07, 95% CI: 2.49-6.67). Women who received their prenatal care from an obstetrician were more likely to visit a walk-in clinic (OR = 1.51, 95% CI: 1.11-2.05) than those who were cared for by a family physician. Conclusions Prenatal care is a complex entity and referral pathways between care providers and services are not always clear. This can lead to the provision of fragmented care and create opportunities for errors and loss of information. All types of care providers have a role in addressing the full range of health needs that pregnant women experience.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, University of British Columbia, BC Women’s and Children’s Hospital, 4500 Oak St, Vancouver, BC V6H 3N1, Canada
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Nagree Y, Cameron P, Gosbell A, Mountain D. Telephone triage is not the answer to ED overcrowding. Emerg Med Australas 2012; 24:123-6. [PMID: 22487660 DOI: 10.1111/j.1742-6723.2012.01547.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Blank L, Coster J, O'Cathain A, Knowles E, Tosh J, Turner J, Nicholl J. The appropriateness of, and compliance with, telephone triage decisions: a systematic review and narrative synthesis. J Adv Nurs 2012; 68:2610-21. [PMID: 22676805 DOI: 10.1111/j.1365-2648.2012.06052.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This paper is a report of the synthesis of evidence on the appropriateness of, and compliance with, telephone triage decisions. BACKGROUND Telephone triage plays an important role in managing demand for health care. Important questions are whether triage decisions are appropriate and patients comply with them. DATA SOURCES CINAHL, Cochrane Clinical Trials Database, Medline, Embase, Web of Science, and Psyc Info were searched between 1980-June 2010. DESIGN LITERATURE REVIEW Rapid Evidence Synthesis. REVIEW METHODS The principles of rapid evidence assessment were followed. RESULTS We identified 54 relevant papers: 26 papers reported appropriateness of triage decision, 26 papers reported compliance with triage decision, and 2 papers reported both. Nurses triaged calls in most of the studies (n=49). Triage decisions rated as appropriate varied between 44-98% and compliance ranged from 56-98%. Variation could not be explained by type of service or method of assessing appropriateness. However, inconsistent definitions of appropriateness may explain some variation. Triage decisions to contact primary care may have lower compliance than decisions to contact emergency services or self care. CONCLUSION Telephone triage services can offer appropriate decisions and decisions that callers comply with. However, the association between the appropriateness of a decision and subsequent compliance requires further investigation and further consideration needs to be given to the minority of calls which are inappropriately managed. We suggest that a definition of appropriateness incorporating both accuracy and adequacy of triage decision should be encouraged.
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Purc-Stephenson RJ, Thrasher C. Patient compliance with telephone triage recommendations: a meta-analytic review. PATIENT EDUCATION AND COUNSELING 2012; 87:135-142. [PMID: 22001679 DOI: 10.1016/j.pec.2011.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/17/2011] [Accepted: 08/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. METHODS Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). RESULTS Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. CONCLUSION Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. PRACTICE IMPLICATIONS We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call.
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Weinstock J, Burton S, Rash CJ, Moran S, Biller W, Krudelbach N, Phoenix N, Morasco BJ. Predictors of engaging in problem gambling treatment: data from the West Virginia Problem Gamblers Help Network. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2011; 25:372-9. [PMID: 21480678 DOI: 10.1037/a0023240] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gambling help-lines are an essential access point, or frontline resource, for treatment seeking. This study investigated treatment engagement after calling a gambling help-line. From 2000-2007 over 2,900 unique callers were offered an in-person assessment appointment. Logistic regression analyses assessed predictors of (a) accepting the referral to the in-person assessment appointment and (b) attending the in-person assessment appointment. Over 76% of callers accepted the referral and 55% of all callers attended the in-person assessment appointment. This treatment engagement rate is higher than typically found for other help-lines. Demographic factors and clinical factors such as gender, severity of gambling problems, amount of gambling debt, and coercion by legal and social networks predicted engagement in treatment. Programmatic factors such as offering an appointment within 72 hr also aided treatment engagement. Results suggest gambling help-lines can be a convenient and confidential way for many individuals with gambling problems to access gambling-specific treatment. Alternative services such as telephone counseling may be beneficial for those who do not engage in treatment.
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Hansen EH, Hunskaar S. Understanding of and adherence to advice after telephone counselling by nurse: a survey among callers to a primary emergency out-of-hours service in Norway. Scand J Trauma Resusc Emerg Med 2011; 19:48. [PMID: 21892945 PMCID: PMC3177778 DOI: 10.1186/1757-7241-19-48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/05/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate how callers understand the information given by telephone by registered nurses in a casualty clinic, to what degree the advice was followed, and the final outcome of the condition for the patients. METHODS The study was conducted at a large out-of-hours inter-municipality casualty clinic in Norway during April and May 2010. Telephone interviews were performed with 100 callers/patients who had received information and advice by a nurse as a sole response. Six topics from the interview guide were compared with the telephone record files to check whether the caller had understood the advice. In addition, questions were asked about how the caller followed the advice provided and the patient's outcome. RESULTS 99 out of 100 interviewed callers stated that they had understood the nurse's advice, but interpreted from the telephone records, the total agreement for all six topics was 82.6%. 93 callers/patients stated that they followed the advice and 11 re-contacted the casualty clinic. 22 contacted their GP for the same complaints the same week, of whom five patients received medical treatment and one was hospitalised. There were significant difference between the native-Norwegian and the non-native Norwegian regarding whether they trusted the nurse (p = 0.017), and if they got relevant answers to their questions (p = 0.005). CONCLUSION Callers to the out-of-hours service seem to understand the advice given by the registered nurses, and a large majority of the patients did not contact their GP or other health services again with the same complaints. PRACTICE IMPLICATION Medical and communicative training must be an important part of the continuous improvement strategy within the out-of-hour services.
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Affiliation(s)
- Elisabeth Holm Hansen
- National Centre for Emergency Primary Health Care, Uni Health, Kalfarveien 31, NO-5018 Bergen, Norway.
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Tourtier JP, Le Moullec D, Mangouka L, Auroy Y. Follow-through of triage protocol. Fam Pract 2011; 28:350. [PMID: 21177745 DOI: 10.1093/fampra/cmq112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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