Observational study of the implementation of telephone advice nursing in Sweden: did callers follow recommendations and did the rate of healthcare visits change?

Telephone advice nursing is introduced in many countries with one key aim being a reduction of avoidable healthcare visits. The aim of this study was to explore whether callers to a telephone advice nursing service followed the telenurses' recommendations, and whether there was a change in the level and trend of the rate of healthcare visits after the introduction of telephone advice nursing. Observational study. Primary and secondary care in Jönköping Region, Sweden. Telephone advice nursing calls, 6:00-23:00, 2014-2015 (n=185 994) and outpatient healthcare visits 2012-2015 (n=6 877 266). Proportion of callers who visited healthcare within the time period advised by the telenurse. Change in level or trend of the overall rate of healthcare visits per 1000 persons and 4-week period after the introduction of telephone advice nursing, with subgroup analysis for primary and secondary care. 77% of callers who were recommended either to visit healthcare within 24 hours or to 'wait and see' followed the recommendations. There was no significant change in level (-5.15; 95% CI -15.80 to 5.50; p=0.349) or trend (-0.24; 95% CI -0.86 to 0.38; p=0.448) of the overall rate of visits per 1000 persons and 4-week period after the introduction of telephone advice nursing. For the rate of primary care visits, an increase in level (8.01; 95% CI 6.36 to 9.66; p<0.001) and trend (1.28; 95% CI 1.17 to 1.39; p<0.001) were observed. For the rate of secondary care visits, a decrease in level (-8.77, 95% CI -14.41 to -3.13; p=0.004) and trend (-1.03, 95% CI -1.35 to -0.71; p<0.001) were observed. The introduction of telephone advice nursing may have contributed to a shift in the rate of healthcare visits from secondary to primary care.

Informations de copyright

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: AS is employed by Inera AB, a limited company owned by Swedish regions, municipalities as well as the Swedish Association of Local Authorities and Regions (SALAR) that administrates the technical solutions used in 1177. AS conducted this research as part of her master’s degree project in the Master’s programme in Public Health Sciences (track Health Economics, Policy and Management) at the Karolinska Institutet, while she was on leave of absence from her employment. The study findings have been interpreted scientifically by all coauthors, without the involvement of Inera AB, and not in the interest of 1177. All other coauthors (ACW, NZ, and KK) are employed at or affiliated with Karolinska Institutet, Stockholm, Sweden. KK is currently employed by BMS, a pharmaceutical company which is not involved with 1177 in Sweden.