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Empowering patient decision making for integrated care: a telephone advice service positively influencing access to timely appropriate care

Authors:

David Greenfield ,

University of Tasmania, AU
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Nazlee Siddiqui

University of Tasmania, AU
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Abstract

Introduction: Telephone advice service (TAS) operates through consulting with callers, using a computerised decision support system and empowering people towards appropriate emergency care. There is a need to assess TAS’s influence in emergency department (ED) attendance to facilitate integrated care, including understanding integration along clinical, functional and system dimensions. This study addresses the question: what influence does a TAS have on patient’s attendance at an ED?

Methods: Records of 12,741 calls from Healthdirect (HD), a national TAS, were checked against 72,577 ED presentations to a regional hospital, resulting in 2,857 unique matches. The data was matched using the criteria: presentation between January 2016 to December 2017; location; time of call; gender; age; and, diagnosis. TAS callers’ initial care plan, their compliance with TAS’s recommendation to attend ED and TAS’ direction for urgency of care was assessed. Additionally, appropriateness of ED attendance between TAS callers versus non-callers was evaluated. Analysis was through using descriptive statistics.

Results: Callers complied with TAS’s recommendations between 40-53% of the time. TAS advised only one third of callers seek ED care, when they were initially inclined to do so. TAS recommended lower urgency care for all care options, in majority of cases (64-82%). The unique match of 2857 ED presentations had 61% assessed as appropriate, whereas, the non-callers of TAS had 57% appropriate presentations.

TAS’s influence on callers’ care seeking behaviour can be summarised as below:

For the 3534 callers who just sought advide from TAS, not having any prior plan, TAS recommended 50% to go to ED. 

For the 2851 callers who wanted to visit ED, TAS recommended only 32% to go to ED. .

For the 2563 callers who wanted to see GP, TAS recommended 15% to go to ED. 

For the 1525 callers who wanted to see GP, TAS recommended 21% to go to ED. 

Discussions: TAS is adding value in the management of individual patient’s clinical needs by positively influencing patient’s decision-making regarding access, timing and appropriate care. However, many callers, for unknown reasons, opt to act against the TAS advice.

The TAS is empowering individual and the cohort of patients at the intersection of clinical, functional and system dimensions of integration. This we label ‘patient integration’, which is a new dimension of integration driven by patient’s seeking advice and enabled by the availability of the TAS.

Conclusions: The TAS is effective in facilitating appropriate and timely access to ED. 

Lessons learned: The TAS is empowering patient decision-making and integration across the continuum of care.

Limitations:

The study has used data from only one organisation.

Suggestions for Future research

Investigate why callers decide to act for or against TAS professional advice.

How to Cite: Greenfield D, Siddiqui N. Empowering patient decision making for integrated care: a telephone advice service positively influencing access to timely appropriate care. International Journal of Integrated Care. 2019;19(4):369. DOI: http://doi.org/10.5334/ijic.s3369
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Published on 08 Aug 2019.

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