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.
Emergency Care
Emergency Medicine
Health Services Utilization
Physician Advice
Primary Care
Telephone Triage and Advice (TTA)
Virtual Physicians
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
27 Sep 2023
27 Sep 2023
Historique:
received:
24
03
2023
accepted:
16
07
2023
medline:
29
9
2023
pubmed:
28
9
2023
entrez:
27
9
2023
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 37759257
doi: 10.1186/s12913-023-09821-w
pii: 10.1186/s12913-023-09821-w
pmc: PMC10523598
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1031Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Acad Emerg Med. 2011 Aug;18(8):836-43
pubmed: 21843219
Rural Remote Health. 2018 Jul;18(3):4514
pubmed: 30059629
Patient Educ Couns. 2012 May;87(2):135-42
pubmed: 22001679
BMC Prim Care. 2022 Mar 30;23(1):60
pubmed: 35354438
Acad Emerg Med. 2023 Apr;30(4):310-320
pubmed: 36757685
JMIR Public Health Surveill. 2019 Nov 18;5(4):e13130
pubmed: 31738175
CMAJ Open. 2021 Jun 15;9(2):E635-E641
pubmed: 34131026
Qual Health Res. 2011 Mar;21(3):333-48
pubmed: 21075979
Fam Pract. 2010 Jun;27(3):271-8
pubmed: 20215333
Health Serv Res. 2018 Apr;53(2):1137-1162
pubmed: 28369871
J Chin Med Assoc. 2019 Apr;82(4):282-288
pubmed: 30893267
Can J Nurs Res. 2021 Dec;53(4):397-404
pubmed: 33283543
J Adv Nurs. 2012 Dec;68(12):2610-21
pubmed: 22676805
Int J Equity Health. 2022 Jun 7;21(1):80
pubmed: 35672744
CMAJ Open. 2023 May 23;11(3):E459-E465
pubmed: 37220956
Can J Psychiatry. 2022 Jul;67(7):534-543
pubmed: 34254563
Ann Fam Med. 2019 Mar;17(2):116-124
pubmed: 30858254
Am J Emerg Med. 2021 Jun;44:213-219
pubmed: 32291162
Rural Remote Health. 2016 Oct-Dec;16(4):4268
pubmed: 27817199