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Vainio H, Soininen L, Castrén M, Torkki P. Identifying performance indicators to measure overall performance of telephone triage - a scoping review. Scand J Prim Health Care 2024; 42:38-50. [PMID: 38078730 PMCID: PMC10851803 DOI: 10.1080/02813432.2023.2283188] [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: 09/12/2022] [Accepted: 11/08/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This article aims to summarize performance indicators used in telephone triage services research, and make recommendations for the selection of valid indicators to measure the performance of telephone triage. We describe what kind of frameworks, performance indicators, or variables have been used for evaluating telephone triage performance by systematically mapping the telephone triage performance measurement. The objective was to find measures for each Triple Aim dimension. DESIGN A scoping review method was used following Joanna Briggs Institute guidelines. Using this method, we defined indicators to measure the performance of telephone triage. We used the Triple Aim framework to identify indicators to measure the overall performance of telephone triage. The Triple Aim framework consists of improving the patient experience of care, improving the health of populations, and reducing cost per capita. SETTING The scoping review was performed using CINAHL, Medline, EBSCOhost, and PubMed electronic databases. The eligibility criterion was research published in English between 2015 and 2023. The inclusion focused on the use and performance of telephone triage services and system-focused studies. RESULTS A total of 1098 papers were screened for inclusion, with 57 papers included in our review. We identified 13 performance indicators covering all Triple Aim dimensions: waiting times, access, patient satisfaction, the accuracy of triage decision, severity and urgency of the symptoms, triage response, patient compliance with the advice given, follow-up healthcare service use, and running costs of service. We didn't find any earlier framework covering all Triple Aim dimensions properly. CONCLUSIONS Measuring the performance of telephone triage requires an extensive and comprehensive approach. We presented performance indicators that may be included in the framework for measuring the performance of telephone triage to support overall performance measurements of telephone triage.
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Affiliation(s)
- Hanna Vainio
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Leena Soininen
- DigiFinland Ltd., University of Helsinki, Helsinki, Finland
| | - Maaret Castrén
- Emergency Medicine, Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Hertens S, Van der Mullen C, Schoenmakers B. The feasibility of teleconsultations in unplanned primary care: an intervention study in Belgium, 2021. Arch Public Health 2023; 81:43. [PMID: 36964630 PMCID: PMC10037370 DOI: 10.1186/s13690-023-01058-7] [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: 06/24/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION Since 2000, an increasing misuse of emergency services in Belgium was noticed. In 2015, a multidisciplinary task-force designed a triage system. Trained operators and integrated triage protocols were installed in a call center for life-threatening and non-life-threatening care needs. Teleconsultations by telephone find their way to planned care and are well studied in this context. Also unplanned care might benefit from telephone-consultations. METHOD This intervention study investigated the feasibility of teleconsultations in unplanned care according to medical doctors. They were present at the call center during the weekend and on public holidays in the period of April 17, 2021 to November 21, 2021. Their task was to call patients who had contacted the call center to perform a teleconsultation, without interfering with regular care. RESULTS 21 triage doctors participated in the study, they completed 59 surveys and conducted 551 teleconsultations. They perceived the quality of the consultations as good with an average score of 82.85 out of 100 on the sliding scale. The doctors gave an average score of 72.40 for the level of certainty for diagnosis and treatment. For 415 consultations, triage doctors judged that the consultation would gain certainty if followed by a physical examination. Video was mainly considered to be valuable in psychiatric problems, allergic reactions and skin problems. DISCUSSION This study showed that teleconsultations are feasible in unplanned care. Videos add value in particular cases. Only few barriers are reported in terms of communication, technology and equipment. CONCLUSION Teleconsultations in unplanned primary care could be performed with a high quality and a sufficient level of certainty. The willingness to conduct teleconsultations in unplanned care is high. It would be useful in a future study to investigate the feasibility, obstacles and needs for implementation of video consultations as they may differ from teleconsultations.
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Affiliation(s)
- Sarah Hertens
- Department of General Practice and Chronic Care, VUB, Laarbeeklaan 103, Brussel (Jette), 1090, Belgium
| | - Chris Van der Mullen
- Department of Public Health and Primary Care, KU Leuven, KU Leuven, Kapucijnenvoer 7, box 7001, Leuven, 3000, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, KU Leuven, KU Leuven, Kapucijnenvoer 7, box 7001, Leuven, 3000, Belgium.
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Graversen DS, Pedersen AF, Christensen MB, Folke F, Huibers L. Factors associated with undertriage and overtriage in telephone triage in Danish out-of-hours primary care: a natural quasi-experimental cross-sectional study of randomly selected and high-risk calls. BMJ Open 2023; 13:e064999. [PMID: 36940945 PMCID: PMC10030474 DOI: 10.1136/bmjopen-2022-064999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
OBJECTIVES We aim to explore undertriage and overtriage in a high-risk patient population and explore patient characteristics and call characteristics associated with undertriage and overtriage in both randomly selected and in high-risk telephone calls to out-of-hours primary care (OOH-PC). DESIGN Natural quasi-experimental cross-sectional study. SETTING Two Danish OOH-PC services using different telephone triage models: a general practitioner cooperative with GP-led triage and the medical helpline 1813 with computerised decision support system-guided nurse-led triage. PARTICIPANTS We included audio-recorded telephone triage calls from 2016: 806 random calls and 405 high-risk calls (defined as patients ≥30 years calling with abdominal pain). MAIN OUTCOME MEASURES Twenty-four experienced physicians used a validated assessment tool to assess the accuracy of triage. We calculated the relative risk (RR) for clinically relevant undertriage and overtriage for a range of patient characteristics and call characteristics. RESULTS We included 806 randomly selected calls (44 clinically relevant undertriaged and 54 clinically relevant overtriaged) and 405 high-risk calls (32 undertriaged and 24 overtriaged). In high-risk calls, nurse-led triage was associated with significantly less undertriage (RR: 0.47, 95% CI 0.23 to 0.97) and more overtriage (RR: 3.93, 95% CI 1.50 to 10.33) compared with GP-led triage. In high-risk calls, the risk of undertriage was significantly higher for calls during nighttime (RR: 2.1, 95% CI 1.05 to 4.07). Undertriage tended to be more likely for calls concerning patients ≥60 years compared with 30-59 years (11.3% vs 6.3%) in high-risk calls. However, this result was not significant. CONCLUSION Nurse-led triage was associated with less undertriage and more overtriage compared with GP-led triage in high-risk calls. This study may suggest that to minimise undertriage, the triage professionals should pay extra attention when a call occurs during nighttime or concerns elderly. However, this needs confirmation in future studies.
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Affiliation(s)
- Dennis Schou Graversen
- Research Unit General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anette Fischer Pedersen
- Research Unit General Practice, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Morten Bondo Christensen
- Research Unit General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Fredrik Folke
- Emergency Medical Services Copenhagen, Copenhagen University Hospital, Ballerup, Denmark
- Department of Cardiology-Herlev and Gentofte, Copenhagen University Hospital, Copenhagen, Denmark
| | - L Huibers
- Research Unit for General Practice, Aarhus University Research Unit General Practice, Aarhus, Midtjylland, Denmark
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Engeltjes B, van Herk N, Visser M, van Wijk A, Cronie D, Rosman A, Scheele F, Wouters E. Patients' experiences with an obstetric telephone triage system: A qualitative study. PATIENT EDUCATION AND COUNSELING 2023; 108:107610. [PMID: 36584556 DOI: 10.1016/j.pec.2022.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Telephone Triage Systems aim to provide a uniform and practical system for healthcare professionals in order to prioritize urgency of care. A disadvantage of telephone triage system could be that the conversations are experienced as less personal, as it uses a uniform procedure for every patient. Therefore, aside from the clinical relevance, patient expectations, experiences and satisfaction were studied. OBJECTIVE The purpose of this study is to explore patients' experiences with obstetric telephone triage. METHODS A descriptive, qualitative design to explore experiences after triage with Dutch Obstetric Telephone Triage System. Participants, recruited from two Dutch hospitals, were pregnant women who received triage by telephone. Semi-structured interviews were held. The following topics were discussed: expectations before triage, experiences with triage, waiting time, information and communication, approach of healthcare professional, and quality of treatment. Data were analyzed using open, axial and selective coding. RESULTS Overall, the participants experienced the telephone conversation as satisfactory. This was due to the perceived professionalism with high accessibility and perceived reassurance. The approach of the professional was experienced as friendly and empathetic. Participants suggested that triage services could be improved by looking specifically at information provision. Explaining in advance how the service works can be helpful to create more awareness and to align better with expectations. CONCLUSION Participants reported that they could tell their own story and most participants realized that the professional asked extra questions in order to quantify the seriousness of the complaints. The level of involvement in the next steps of their care episode experienced by respondents lead us to conclude that the professional intended patient-centered care. PRACTICE IMPLICATIONS Improving the provision of information during waiting times and about the accessibility of the service can increase the quality of obstetric triage care. Patient involvement is necessary to increase trust and to meet the needs of the patient.
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Affiliation(s)
- Bernice Engeltjes
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
| | - Nikki van Herk
- Department of Obstetrics and Gynecology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Maud Visser
- Department of Obstetrics and Gynecology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Astrid van Wijk
- Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
| | - Doug Cronie
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena institute for transdisciplinary research, Faculty of science, VU University, Amsterdam, the Netherlands; Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Rodrigues D, Kreif N, Saravanakumar K, Delaney B, Barahona M, Mayer E. Formalising triage in general practice towards a more equitable, safe, and efficient allocation of resources. BMJ 2022; 377:e070757. [PMID: 35609904 DOI: 10.1136/bmj-2022-070757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniela Rodrigues
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Noemi Kreif
- Centre for Health Economics, University of York, York, UK
| | | | - Brendan Delaney
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mauricio Barahona
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Erik Mayer
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Cotte F, Mueller T, Gilbert S, Blümke B, Multmeier J, Hirsch MC, Wicks P, Wolanski J, Tutschkow D, Schade Brittinger C, Timmermann L, Jerrentrup A. Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study. JMIR Mhealth Uhealth 2022; 10:e32340. [PMID: 35343909 PMCID: PMC9002590 DOI: 10.2196/32340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 02/18/2022] [Indexed: 01/29/2023] Open
Abstract
Background Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app’s urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results Of 378 participants, 344 (91%) were triaged the same or more conservatively and 34 (8.9%) were undertriaged by the app. Of the 378 patients, 14 (3.7%) had received safe advice determined by the expert panel and 20 (5.3%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00024909
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Affiliation(s)
- Fabienne Cotte
- Charité Universitäsmedizin Berlin, Berlin, Germany.,Department of Emergency Medicine, University Clinic Marburg, Philipps-University, Marburg, Germany.,Ada Health GmbH, Berlin, Germany
| | - Tobias Mueller
- Center for Unknown and Rare Diseases, UKGM GmbH, University Clinic Marburg, Philipps-University, Marburg, Germany
| | - Stephen Gilbert
- Ada Health GmbH, Berlin, Germany.,Else Kröner Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | | | - Martin Christian Hirsch
- Ada Health GmbH, Berlin, Germany.,Institute of Artificial Intelligence, Philipps-University Marburg, Marburg, Germany
| | | | | | - Darja Tutschkow
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany, Marburg, Germany
| | - Carmen Schade Brittinger
- Coordinating Center for Clinical Trials, Philipps University Marburg, Marburg, Germany, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
| | - Andreas Jerrentrup
- Department of Emergency Medicine, University Clinic Marburg, Philipps-University, Marburg, Germany
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Engeltjes B, Rosman A, Bertens LCM, Wouters E, Cronie D, Scheele F. Reliability of Dutch Obstetric Telephone Triage. Risk Manag Healthc Policy 2021; 14:3247-3254. [PMID: 34393531 PMCID: PMC8357617 DOI: 10.2147/rmhp.s319564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Safety and efficiency of emergency care can be optimized with a triage system which uses urgency to prioritize care. The Dutch Obstetric Telephone Triage System (DOTTS) was developed to provide a basis for assessing urgency of unplanned obstetric care requests by telephone. Reliability and validity are important components in evaluating such (obstetric) triage systems. Objective To determine the reliability of Dutch Obstetric Telephone Triage, by calculating the inter-rater and intra-rater reliability. Methods To evaluate the urgency levels of DOTTS by testing inter-rater and intra-rater reliability, 90 vignettes of possible requests were developed. Nineteen participants, from hospitals where DOTTS had been implemented, rated in two rounds a set of ten vignettes. The five urgency levels and five presenting symptoms had an equal spread and had to be entered in accordance with DOTTS per vignette. Urgency levels were dichotomized into high urgency and intermediate urgency. Inter-rater reliability was rated as degree of agreement between two different participants with the same vignette. Intra-rater reliability was rated as agreement by the same participants at different moments in time. The degree of inter-rater and intra-rater reliability was tested using weighted Cohen’s Kappa and ICC. Results The agreement of urgency level between participants in accordance with predefined urgency level per vignette was 90.5% (95% CI 87.5–93.6) [335 of 370]. Agreement of urgency level between participants was 88.5% (95% CI 84.9–93.0) [177 of 200] and 84.9% (95% CI 78.3–91.4) after re-rating [101 of 119]. Inter-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.77 and as ICC 0.87; intra-rater reliability of DOTTS expressed as Cohen’s Kappa was 0.70 and as ICC 0.82. Conclusion Inter-rater and intra-rater reliability of DOTTS showed substantial correlation, and is comparable to other studies. Therefore, DOTTS is considered reliable.
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Affiliation(s)
- Bernice Engeltjes
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Ageeth Rosman
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eveline Wouters
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Doug Cronie
- Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Fedde Scheele
- Athena Institute for Transdisciplinary Research, Faculty of Science, VU University, Amsterdam, the Netherlands.,Department of Healthcare Education, OLVG Teaching Hospital, Amsterdam, the Netherlands
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Schoenmakers B, Van Criekinge J, Boeve T, Wilms J, Van Der Mullen C, Sabbe M. Co-location of out of hours primary care and emergency department in Belgium: patients' and physicians' view. BMC Health Serv Res 2021; 21:282. [PMID: 33771152 PMCID: PMC7995743 DOI: 10.1186/s12913-021-06281-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of low acuity emergency visits. Although this system is well organized, the number of low acuity visits does not decrease. Methods We explored the view of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services and included patients and physicians. Main outcome measure was the view of patients and physician on co-location of a GPC and an emergency service. Results 404 patients and 488 physicians participated. 334 (82.7%) of all patients favoured a co-location. The major advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GPs and 38 (95%) of the emergency physicians were in favour of a co-location. The major advantage was a more adequate referral of patients. 254 (79%) of the GPs and 23 (83%) of the emergency physicians believed that a co-location would lower the workload and waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). Conclusions To close the expectation gap between GP’s, emergency physicians and to reach for high care quality, information campaigns and development of workflows are indispensable for a successful implementation of a co-location of primary and emergency care.
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Affiliation(s)
- Birgitte Schoenmakers
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium.
| | - Jasper Van Criekinge
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Timon Boeve
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Jonas Wilms
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Chris Van Der Mullen
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
| | - Marc Sabbe
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33 box 7001, 3000, Leuven, Belgium
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The implementation of the nationwide out-of-hours phone number 1733 in Belgium: analysis of efficiency and safety. Prim Health Care Res Dev 2021; 22:e7. [PMID: 33715654 PMCID: PMC8060850 DOI: 10.1017/s1463423621000098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Belgium has a problem with inappropriate use of emergency services. The government installed the number 1733 for out-of-hours care. Through a dry run test, we learned that 30% of all calls were allocated to the protocol ‘unclear problem’. In only 11.9% of all cases, there was an unclear problem. Methods: The study aimed to determine whether the adjusted protocol ‘unwell for no clear reason’ led to a safer and more efficient referral and to evaluate the efficiency and safety of the primary care protocols (PCPs). The study ran in cross-sectional design involving patients, General Practitioner Cooperatives and telephone operators. A random sample of calls to 1733 and patient referrals were assessed on efficiency and safety. Results: During 6 months in 2018, 11 622 calls to 1733 were registered. Seven hundred fifty-six of them were allocated to ‘unwell for no clear reason’, and a random sample of 180 calls was audited. To evaluate the PCPs, 202 calls were audited. The efficiency and safety of the protocol ‘unwell for no clear reason’ improved, and safety levels for under- and over-triage were not exceeded. The GP’s judged that 9/10 of all patient encounters were correctly referred. Conclusion: This study demonstrated that the 1733-telephone triage system for out-of-hours care is successful if protocols, flow charts and emergency levels are well defined, monitored and operators are trained.
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Roth C, Breckner A, Paulus J, Wensing M. Implementation of a Standardized Initial Assessment for Demand Management in Outpatient Emergency Care in Germany: Early Qualitative Process Evaluation. JMIR Form Res 2020; 4:e18456. [PMID: 32663159 PMCID: PMC7501577 DOI: 10.2196/18456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/16/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Inadequate assessment of the severity and urgency of medical problems is one of the factors contributing to unnecessary emergency department (ED) visits. The implementation of a software-based instrument for standardized initial assessment-Standardisierte medizinische Ersteinschätzung in Deutschland (SmED) (Standardized medical Initial Assessment in Germany in English)-aims to support health care professionals and steer patients toward the right health care provider. This study aimed to explore the implementation process of SmED from a user perspective. OBJECTIVE This study aims to evaluate the overall perception of SmED by health care professionals using the software, to examine to what extent SmED influences the workload and work routines of health care professionals, and to determine which factors are associated with the use of SmED. METHODS An early qualitative process evaluation on the basis of interviews was carried out alongside the implementation of SmED in 26 outpatient emergency care services within 11 federal states in Germany. Participants were 30 health care professionals who work with SmED either at the joint central contact points of the outpatient emergency care service and the EDs of hospitals (ie, the Joint Counter; Gemeinsamer Tresen in German) or at the initial telephone contact points of the outpatient emergency care service (phone number 116117). Matrix-based framework analysis was applied to analyze the interview data. RESULTS Health care professionals perceived that workload increased initially, due to additional time needed per patient. When using SmED more frequently and over a longer time period, its use became more routine and the time needed per call, per patient, decreased. SmED was perceived to support decision making regarding urgency for medical treatment, but not all types of patients were eligible. Technical problems, lack of integration with other software, and lack of practicability during peak times affected the implementation of SmED. CONCLUSIONS Initial experiences with SmED were positive, in general, but also highlighted organizational issues that need to be addressed to enhance sustainability. TRIAL REGISTRATION German Clinical Trials Register DRKS00017014; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017014.
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Affiliation(s)
- Catharina Roth
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jan Paulus
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Graversen DS, Christensen MB, Pedersen AF, Carlsen AH, Bro F, Christensen HC, Vestergaard CH, Huibers L. Safety, efficiency and health-related quality of telephone triage conducted by general practitioners, nurses, or physicians in out-of-hours primary care: a quasi-experimental study using the Assessment of Quality in Telephone Triage (AQTT) to assess audio-recorded telephone calls. BMC FAMILY PRACTICE 2020; 21:84. [PMID: 32386511 PMCID: PMC7211335 DOI: 10.1186/s12875-020-01122-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
Background To explore and compare safety, efficiency, and health-related quality of telephone triage in out-of-hours primary care (OOH-PC) services performed by general practitioners (GPs), nurses using a computerised decision support system (CDSS), or physicians with different medical specialities. Methods Natural quasi-experimental cross-sectional study conducted in November and December 2016. We randomly selected 1294 audio-recorded telephone triage calls from two Danish OOH-PC services triaged by GPs (n = 423), nurses using CDSS (n = 430), or physicians with different medical specialities (n = 441). An assessment panel of 24 physicians used a validated assessment tool (Assessment of Quality in Telephone Triage - AQTT) to assess all telephone triage calls and measured health-related quality, safety, and efficiency of triage. Results The relative risk (RR) of poor quality was significantly lower for nurses compared to GPs in four out of ten items regarding identifying and uncovering of problems. For most items, the quality tended to be lowest for physicians with different medical specialities. Compared to calls triaged by GPs (reference), the risk of clinically relevant undertriage was significantly lower for nurses, while physicians with different medical specialties had a similar risk (GP: 7.3%, nurse: 3.7%, physician: 6.1%). The risk of clinically relevant overtriage was significantly higher for nurses (9.1%) and physicians with different medical specialities (8.2%) compared to GPs (4.3%). GPs had significantly shorter calls (mean: 2 min 57 s, SD: 105 s) than nurses (mean: 4 min 44 s, SD: 168 s). Conclusions Our explorative study indicated that nurses using CDSS performed better than GPs in telephone triage on a large number of health-related items, had a lower level of clinically relevant undertriage, but were perceived less efficient. Calls triaged by physicians with different medical specialities were perceived less safe and less efficient compared to GPs. Differences in the organisation of telephone triage may influence the distribution of workload in primary and secondary OOH services. Future research could compare the long-term outcomes following a telephone call to OOH-PC related to safety and efficiency.
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Affiliation(s)
- D S Graversen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - M B Christensen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - A F Pedersen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A H Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - F Bro
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - H C Christensen
- Emergency Medical Services, Copenhagen, Denmark.,The National Clinical Databases (RKKP), Copenhagen, Denmark
| | - C H Vestergaard
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - L Huibers
- Research Unit for General Practice, Aarhus, Bartholins Allé 2, 8000, Aarhus C, Denmark
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12
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Morreel S, Philips H, Colliers A, Verhoeven V. Performance of a new guideline for telephone triage in out-of-hours services in Belgium: A pilot study using simulated patients. Health Serv Manage Res 2020; 33:166-171. [PMID: 32362149 DOI: 10.1177/0951484820921809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients in Belgium needing out-of-hours care have two options: the emergency department or the general practitioner on call often organised in a general practitioner cooperative. Currently, there is no triage system in Belgium so patients do not know where to go. METHODS Our primary objective was to examine the ability of a newly developed telephone guideline, called 1733, to adequately estimate the urgency of health problems presented by simulated patients. Ten clinical vignettes were presented to 12 operators in a simulated phone call. The operators had to assign a protocol, urgency level and resource to dispatch (ambulance, general practitioner house visit, etc.) to each case. RESULTS A total of 120 phone calls were analysed. The operators chose the right protocol in 69% and the correct urgency level in 35% of the cases. The proportion of under- and over-triage was 26% and 39%, respectively. There was important variation in between the operators. The sensitivity for detecting highly urgent cases was 0.42, the specificity 0.92. CONCLUSION Using the new Belgian 1733 guideline for telephone triage, operators mostly chose the appropriate protocol but only chose the correct urgency in one out of three cases. In this phase of development, the studied telephone guideline is not ready for implementation.
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Affiliation(s)
- Stefan Morreel
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Hilde Philips
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Annelies Colliers
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Veronique Verhoeven
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
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13
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Ability of the wider dental team to triage patients with acute conditions: a qualitative study. Br Dent J 2020; 228:103-107. [DOI: 10.1038/s41415-020-1199-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Keizer E, Christensen MB, Carlsen AH, Smits M, Wensing M, Senn O, Huibers L. Factors related to out-of-hours help-seeking for acute health problems: a survey study using case scenarios. BMC Public Health 2019; 19:33. [PMID: 30621741 PMCID: PMC6323727 DOI: 10.1186/s12889-018-6332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background The acute out-of-hours healthcare services are challenged by increasing demand in many countries. We aimed to examine factors influencing the intended help-seeking in out-of-hours care for acute health problems during evenings, nights, and weekends. Methods We conducted a survey study based on data from parents of children (aged 0–4 years) and adults (aged 30–39 and 50–59 years) in Denmark, the Netherlands and Switzerland. Intended help-seeking behaviour was measured by six hypothetical case scenarios. We used Andersen’s Behavioural Model to categorise potentially influential factors and applied multiple binomial regression to assess the influence of selected factors. Results A total of 1015 parents and 2942 adults participated. We identified several significant influential factors. Parents holding a low education (OR 1.56), having migrant background (western: OR 1.23; non-western: OR 1.93), having one child (OR 1.24), perceiving few barriers to using out-of-hours primary care (OR 1.59), perceiving difficulties with organising childcare (OR 1.13), and having a history of frequent contacts with out-of-hours care (OR 1.55) were more inclined to contact out-of-hours care, whereas female (OR 0.85) and non-anxious parents (OR 0.77) were less inclined. Adults who were older (OR 1.01), holding a medical education (OR 1.13), having non-western background (OR 1.28), being unemployed (OR 1.17), perceiving few barriers to using out-of-hours primary care (OR 1.37), and having a history of frequent contacts with a GP (few: OR 1.15; more: OR 1.22) and/or with out-of-hours care (one: OR 1.20; more: OR 1.49) were more inclined to contact out-of-hours care, whereas adults with no or little social support (OR 0.84) and adults with high health literacy level on health information (OR 0.91) were less inclined. Dutch parents were less inclined than Danish parents to contact out-of-hours care (OR 0.62), whereas Swiss adults were more inclined than Danish adults to contact out-of-hours care (OR 1.16). Conclusion We identified several factors related to intended help-seeking in out-of-hours care. These results could be used to develop targeted interventions, but more research is needed to examine the underlying explanations for the identified differences. Electronic supplementary material The online version of this article (10.1186/s12889-018-6332-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | | | - Anders Helles Carlsen
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Michel Wensing
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland
| | - Linda Huibers
- Research Unit for General Practice, Aarhus, Bartholins Alle 2, DK-8000, Aarhus, Denmark
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15
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Huibers L, Keizer E, Carlsen AH, Moth G, Smits M, Senn O, Christensen MB. Help-seeking behaviour outside office hours in Denmark, the Netherlands and Switzerland: a questionnaire study exploring responses to hypothetical cases. BMJ Open 2018; 8:e019295. [PMID: 30341108 PMCID: PMC6196844 DOI: 10.1136/bmjopen-2017-019295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/11/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aim to study the preferred behaviour among individuals from different age groups in three countries when acute health problems occur outside office hours and thereby to explore variations in help-seeking behaviour. DESIGN A questionnaire study exploring responses to six hypothetical cases describing situations with a potential need for seeking medical care and questions on background characteristics. SETTING General population in Denmark, the Netherlands and Switzerland. POPULATION Danish, Dutch and Swiss individuals from three age groups (0-4, 30-39, 50-59 years). MAIN OUTCOME MEASURES Distribution of intended help-seeking preferences per case per age group, compared between countries. Differences in percentage of help-seeking outside office hours per age group and country, crude and adjusted for background characteristics. RESULTS Danish and Dutch parents of children aged 0-4 years differed in intended help-seeking behaviour for five out of six cases (abdominal pain, red eyes, rash, relapse fever, chickenpox); Danish parents significantly more often chose to contact out-of-hours (OOH) care than Dutch parents. For adults aged 30-39 years, no significant difference between the three countries was found for contacting OOH care. Swiss adults aged 50-59 years had the highest percentage of OOH contacts (38.3%), followed by the Danish (33.4%) and the Dutch (32.5%). CONCLUSION Some differences in help-seeking behaviour outside office hours exist between Danish, Dutch and Swiss individuals, particularly for parents of young children. The question remains whether these differences result from individual preferences, cultural disparities and/or health services variations. Future research should focus on identifying explanations for these differences to reduce undesirable use of OOH care.
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Affiliation(s)
| | - Ellen Keizer
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
| | | | - Grete Moth
- Research Unit for General Practice, Aarhus, Denmark
| | - Marleen Smits
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Zurich, Switzerland
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16
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Giesen MJ, Keizer E, van de Pol J, Knoben J, Wensing M, Giesen P. The impact of demand management strategies on parents' decision-making for out-of-hours primary care: findings from a survey in The Netherlands. BMJ Open 2017; 7:e014605. [PMID: 28487458 PMCID: PMC5623343 DOI: 10.1136/bmjopen-2016-014605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the potential impact of demand management strategies on patient decision-making in medically non-urgent and urgent scenarios during out-of-hours for children between the ages of 0 and 4 years. DESIGN AND METHODS We conducted a cross-sectional survey with paper-based case scenarios. A survey was sent to all 797 parents of children aged between 0 and 4 years from four Dutch general practitioner (GP) practices. Four demand management strategies (copayment, online advice, overview medical cost and GP appointment next morning) were incorporated in two medically non-urgent and two urgent case scenarios. Combining the case scenarios with the demand management strategies resulted in 16 cases (four scenarios each with four demand management strategies). Each parent randomly received a questionnaire with three different case scenarios with three different demand strategies and a baseline case scenario without a demand management strategy. RESULTS The response rate was 47.4%. The strategy online advice led to more medically appropriate decision-making for both non-urgent case scenarios (OR 0.26; CI 0.11 to 0.58) and urgent case scenarios (OR 0.16; CI 0.08 to 0.32). Overview of medical cost (OR 0.59; CI 0.38 to 0.92) and a GP appointment planned the next morning (OR 0.57; CI 0.34 to 0.97) had some influence on patient decisions for urgent cases, but not for non-urgent cases. Copayment had no influence on patient decisions. CONCLUSION Online advice has the highest potential to reduce medically unnecessary use. Furthermore it enhanced safety of parents' decisions on seeking help for their young children during out-of-hours primary care. Valid online information on health symptoms for patients should be promoted.
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Affiliation(s)
- Marie-Jeanne Giesen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
- TiasNimbas Business School, Tilburg University, Tilburg, the Netherlands
| | - Ellen Keizer
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Julia van de Pol
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joris Knoben
- Institute for Management Research, Radboud University, Nijmegen, the Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Giesen
- Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
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17
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Dahlgren K, Holzmann MJ, Carlsson AC, Wändell P, Hasselström J, Ruge T. The use of a Swedish telephone medical advice service by the elderly - a population-based study. Scand J Prim Health Care 2017; 35:98-104. [PMID: 28277048 PMCID: PMC5361425 DOI: 10.1080/02813432.2017.1288816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The present study aimed to describe contact made by the elderly to Sweden's nationwide medical helpline, Healthcare Guide 1177 by Phone (HGP). Other objectives were to study potential gender differences and the association between different HGP referral levels and acute visits to hospital-based emergency departments and acute visits to primary care centres. DESIGN De-identified data from recorded calls to HGP was extracted for analysis (n = 7477 for the oldest age group). Information about acute visits to emergency departments and to primary care reception was extracted from the patient administration system. SETTING Västerbotten County, Sweden. SUBJECTS Patients over 80 years. MAIN OUTCOME MEASURES Calling and visiting frequencies for different age groups as well as reasons for contact and individual recommendations. RESULTS The utilisation rate of the telephone advice service for the oldest age group was high, with an incidence rate of 533 per 1000 person-years. Women had a 1.17 times higher incidence rate compared with men. The most common reason for contact was drug-related questions (17% of all contacts). Calls that were recommended to care by a medical specialist correlated with total emergency department visits (r = 0.30, p < 0.05) and calls that were given advice correlated with acute primary healthcare visits (r = 0.38, p = 0.005). CONCLUSION The high utilisation of the telephone advice service by the elderly gives the telephone advice service a unique ability to function as a gatekeeper to further healthcare. Our data suggest that with the telephone advice service's present guidelines, a significant proportion of all calls are being directed to further medical help. The high frequency of drug-related questions raises concerns about the elderly's medication regimens. Key points Patients over 80 years of age had a high utilisation of the telephone medical advice service compared with other age groups. Drug-related questions were the most common reason for contact. A significant proportion of all calls made resulted in further heatlhcare contacts.
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Affiliation(s)
- K. Dahlgren
- Department of Surgery, Emergency Care, Umeå University, Umeå, Sweden
| | - M. J. Holzmann
- Department of Emergency Medicine, Karolinska University Hospital, Sweden
| | - A. C. Carlsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - P. Wändell
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - J. Hasselström
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T. Ruge
- Department of Surgery, Emergency Care Umeå University, Umeå, Sweden
- CONTACT Toralph Ruge Department of Surgery, Emergency Care, Umeå University, Umeå, SE-90185 Sweden
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18
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Rashid A. Yonder: Rosacea, youth mental health, diagnosing arthritis, and telephone triage. Br J Gen Pract 2016; 66:199. [PMID: 27033488 PMCID: PMC4809691 DOI: 10.3399/bjgp16x684565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- University of Cambridge, Cambridge. E-mail: @Dr_A_Rashid
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