Compliance with telephone triage advice among adults aged 45 years and older: an Australian data linkage study

Abstract

BackgroundMiddle-aged and older patients are prominent users of telephone triage services for timely access to health information and appropriate referrals. Non-compliance with advice to seek appropriate care could potentially lead to poorer health outcomes among those patients. It is imperative to assess the extent to which middle-aged and older patients follow triage advice and how this varies according to their socio-demographic, lifestyle and health characteristics as well as features of the call.MethodsRecords of calls to the Australian healthdirect helpline (July 2008–December 2011) were linked to baseline questionnaire data from the 45 and Up Study (participants age ≥ 45 years), records of emergency department (ED) presentations, hospital admissions, and medical consultation claims. Outcomes of the call included compliance with the advice “Attend ED immediately”; “See a doctor (immediately, within 4 hours, or within 24 hours)”; “Self-care”; and self-referral to ED or hospital within 24 h when given a self-care or low-urgency care advice. Multivariable logistic regression was used to investigate associations between call outcomes and patient and call characteristics.ResultsThis study included 8406 adults (age ≥ 45 years) who were subjects of 11,088 calls to the healthdirect helpline. Rates of compliance with the advices “Attend ED immediately”, “See a doctor” and “Self-care” were 68.6%, 64.6% and 77.5% respectively, while self-referral to ED within 24 h followed 7.0% of calls. Compliance with the advice “Attend ED immediately” was higher among patients who had three or more positive lifestyle behaviours, called after-hours, or stated that their original intention was to attend ED, while it was lower among those who lived in rural and remote areas or reported high or very high levels of psychological distress. Compliance with the advice “See a doctor” was higher in patients who were aged ≥65 years, worked full-time, or lived in socio-economically advantaged areas, when another person made the call on the patient’s behalf, and when the original intention was to seek care from an ED or a doctor. It was lower among patients in rural and remote areas and those taking five medications or more. Patients aged ≥65 years were less likely to comply with the advice “Self-care”. The rates of self-referral to ED within 24 h were greater in patients from disadvantaged areas, among calls made after-hours or by another person, and when the original intention was to attend ED. Patients who were given a self-care or low-urgency care advice, whose calls concerned bleeding, cardiac, gastrointestinal, head and facial injury symptoms, were more likely to self-refer to ED.ConclusionsCompliance with telephone triage advice among middle-age and older patients varied substantially according to both patient- and call-related factors. Knowledge about the patients who are less likely to comply with telephone triage advice, and about characteristics of calls that may influence compliance, will assist in refining patient triage protocols ...

Potential of a nurse telephone triage line to direct elderly to appropriate health care settings

“…Contrary to previous studies (Blank et al, ; Bogdan et al, ; Tran et al, ), patients self‐reported slightly higher intention to comply with recommendations for the lowest care. The lowest rate of intention to comply with “urgent GP care” may have been a reflection of the unique challenges in accessing urgent primary care in Portugal (Correia, Norwood, Watson, & Veiga, ).…”

“…User non‐compliance may limit the impact of telephone triage and advice. In this study, the intentions to comply with nurse's disposition were slightly higher than the compliance rates and self‐reported compliance rates that have been reported in related literature (Blank et al, ; Bogdan et al, ; Delichatsios et al, ; Foster, ; Hansen & Hunskaar, ; Rimner, Blozik, Begley, Grandchamp, & Overbeck, ; Stewart, Fairhurst, Markland, & Marzouk, ; Tran et al, ). Moreover, contrary to Tran et al (), compliance did not appear to vary substantially according to observable patient characteristics.…”

“…A better match between needs of patients and the health care settings, and adequate self‐care can lead to a more efficient use of health care resources and contribute to reduce costs (Bogdan et al, ; Lambert, Fordham, Large, & Gaffney, ; Lattimer et al, ; Marklund et al, ; Navratil‐Strawn et al, ). Nonetheless, interactional factors may impact the performance of health advice lines (Lake et al, ; Tran et al, ).…”

The lived experience of rescuing people who have driven into floodwater: Understanding challenges and identifying areas for providing support

“…In response to Challenge 2, the design and consistent application of a standard operating procedure for emergency telephone operators when speaking to people who have their vehicle stranded in floodwater would be beneficial in that it may reduce rescuee behaviour which increase the risk or complicate the rescue. Quality of telephone operator communication has been found to encourage compliance with operator instructions during telephone triage, which is an identified issue for healthcare telephone triage on helplines such as the Australian Healthdirect helpline . An example in the context of flood rescue is if a vehicle has just submerged into water then protocols such as “seatbelt off, window down, release children, get out” can be an easy, consistent and life‐saving message to convey.…”

Calling for confirmation, reassurance, and direction: Investigating patient compliance after accessing a telephone triage advice service

“…The reported levels of compliance with TTAS's recommendation to attend ED, varied from the earlier published range; that is, 29‐69% compared to 52‐68% . Variation in compliance rates is a known issue .…”