Satisfaction and Public Health Cost of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza

Abstract

BackgroundThe 2009 H1N1 pandemic strained healthcare systems. There was a need for supportive services, rapid antiviral access, and minimization of unnecessary healthcare contacts particularly face-to-face interactions. In response, the Minnesota Department of Health (MDH) launched a telephone-based nurse triage line (NTL) called the Minnesota FluLine coordinating all major MN healthcare systems with NTLs to form a single toll-free number triage service. Callers were evaluated for symptoms of influenza-like illness (ILI) and were prescribed an antiviral if indicated, using nurse administered protocols.MethodsTo determine caller outcomes, associated healthcare seeking, and satisfaction a telephone survey of Minnesota FluLine callers was conducted using a 5% random sample of those who completed the protocol and those who did not.ResultsOf 6,122 callers with ILI who began the nurse protocol administered by the contract NTL, 1,221 people were contacted for the survey and 325 agreed to participate; response rate was 26%. Of those who completed the nurse protocol 73% said they would have sought healthcare without the Minnesota FluLine, 89% reported the service was moderately or very helpful, and 91% reported being satisfied or very satisfied. Of those not completing the protocol, 50% reported the service was moderately or very helpful and 50% reported being satisfied or very satisfied. 72% of qualitative responses to open-ended questions were positive regarding the MN FluLine. Cost to MDH for operating the Minnesota FluLine service was $331,226 to service 27,391 callers ($12.09/call).DiscussionThe Minnesota FluLine diverted patients with mild ILI symptoms away from acute care visits at low cost and had a high rate of satisfaction among callers. Early intervention likely prevented morbidity and possibly additional cases. NTLs are powerful and flexible tools for pandemic response and should be considered as an important tool for future emergency responses.

Cost analysis of an integrated aged care program for residential aged care facilities

“…Cost per call was found to be $268, which is higher when compared with findings of other studies of telephone triage services. 8,10,30,31 About 80% of all ED presentations from RACFs were not associated with prior ACE calls ( Table 2).…”

“…Although the present study identified savings from ACE, the cost per phone call of A$268 is relatively high when compared with those found in other studies. 8,10,30,31 However, as pointed out by Cullen and Wilson, cost-effectiveness is usually achieved in telephone triage services with large scale operations; they found that the average cost per call for six general practice triage services was A$162, 30 whereas the Western Australia Health Call Centre telephone triage service had a per-call cost of A$23. 32 The ACE program receives a relatively small number of calls compared with major triage services for general populations.…”

Facilitating Access to Antiviral Medications and Information During an Influenza Pandemic: Engaging with the Public on Possible New Strategies

“…23,24 An important theme voiced by participants across all sessions relates to using several simultaneous strategies-a ''layered'' approach-to facilitate access to antivirals. Participants recognized that no single strategy can solve the full range of problems that might emerge during a severe pandemic.…”

“…25 They could foresee the potential limitations of each strategy-for instance, the possibility that telephone triage lines could become overwhelmed, a situation that Minnesota's FluLine had to address during the H1N1 pandemic. 23 Yet, they understood that several of these strategies combined could enhance their efficacy. This realization may have been responsible for the high overall acceptability of the alternative strategies despite the noted deficiencies of each.…”

On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

“…During the 2009 H1N1 pandemic, nurse triage lines reduced in-person visits for influenza-like symptoms, were cost effective, had a high degree of satisfaction among callers, and were able to reach rural and uninsured populations. [4,5,6,7] Reaching vulnerable populations and those of lower socioeconomic status (SES) during a pandemic is of particular importance as individuals of lower SES have greater barriers to information access and are more likely to adopt incorrect protective behaviors. [8] To further promote telehealth in the COVID-19 era, throughout March and April of 2020 federal and state policies have been altered to remove or ease geographic restrictions and other regulatory barriers to telehealth visits.…”