Medical telephone triage and subsequent patient behaviour : How do they compare ?

Medvantis Medi-24 is the first medical call centre in Switzerland and has been operational since May 2000. Various health care insurance companies provide this service and advertise it amongst their customers. Since August 2001 the service is also used by several general practitioner cooperatives for their out-of-hours calls. Whilst the insured person pays a local telephone-fee, the insurance company reimburses the medical communication centre on a combined capitation and fee for service base. In 2001 the communication centre handled a call-volume of 25,397 calls. The service is available 24 hours a day, 7 days a week and covers the German, French and (since April 2003) Italian speaking regions of Switzerland. It provides general medical information in addition to telephone triage. The staff of the medical call centre consists of 20 nurses with an average job experience of 15 years in various health care institutions. They undergo a six week full-time special training prior to starting their job as health advisors in the communication centre. The nurses are supported 24 hours a day by four board approved general practitioners and internists. For the triage the nurse is assisted by a computerised decision support system (TAS/Plain Software Company/UK). TAS was designed by the University of Warwick. It is based on a series of UK studies which have defined nurses’ telephone consultation practice, their training and their decision support needs in a variety of different settings. The system is being further developed in an ongoing international process (UK, Holland, Switzerland). The telephone triage system is based on the assumption that with a high probability (medical) laymen will without appropriate advice utilize treatment options inappropriate for their specific health problems. The wrong choice of service by a patient, such as unnecessary use of emergency services, can cause considerable expense. On the other hand, lack of action and failure to use the health care services offered, could result in serious health problems and, in the longer term, also lead to increasing costs. Consequently, there is a need to evaluate the benefits of this new service for the Swiss health market. While the NHS Direct service has already been evaluated to a great extent [1, Questions under study: In the medical call centre Medi-24, medical experts advise people with health problems on the optimal treatment. The purpose of the first part of this study was to answer two questions: To what extend do callers and medical experts differ in their judgement of a health problem, and to what degree are patients compliant to experts’ advice. Methods: 834 callers were selected for study inclusion. At the call centre, study participants were asked about their intended behaviour prior to the call and approximately 90% of these were interviewed one week later about their subsequent behaviour following the call. The standardised data were analysed fitting a logistic regression model. Results: 61% of callers had not intended to behave the way they were subsequently advised to do. The compliance rate after the triage call was 56%. Non-compliance was largely due to the caller’s recollection errors or to a change in the perceived intensity of the health problem. Advice on self-care resulted in an above average compliance. A high compliance was also found when the advice on emergency treatment coincided with the patient’s own intended emergency treatment. Conclusion: The high compliance for the selfcare advice showed that patients could be persuaded by the Medi-24 service that professional health care was not necessary. It appeared more difficult to persuade those patients to make an emergency consultation who had initially not intended to do so.