Modeling the effects of telephone nursing on healthcare utilization

Abstract

We present a robust Bayesian ordinal regression model that predicts three-quarters of the patients' healthcare utilization after telephone nursing and we found no evidence of model deficiencies. A patient's compliance to the nurse's recommendation varies and depends on the recommended level of care, its agreement with and level of the patient's prior intention, and the availability of different care options at the time. The model reveals a risk reducing behavior among patients and the effect of the telephone nursing recommendation is 7 times higher than the effect of the patient's intended action prior to consultation if the recommendation is the highest level of care. But the effect of the nurse's recommendation is lower, or even non-existing, if the recommendation is self-care. Telephone nursing was found to have a constricting effect on healthcare utilization, however, the compliance to nurse's recommendation is closely tied to perceptions of risk, emphasizing the importance to address caller's needs of reassurance.

Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study

“…The most valuable and relevant new evidence is from research that has started to investigate the more complex patient and system factors that can explain variation and behaviours. There is an emerging theme about the important relationships between caller expectations, intended action, attitudes to risk, agreement with triage decision and subsequent satisfaction and utilisation of services, 26,27,38,39 together with environmental factors such as rurality and deprivation, 22,23 all of which need to be considered as part of service design. There are interesting developments about how patient-reported characteristics, such as degree of worry, might be incorporated into triage questioning 31,40 and about the effect of language proficiency.…”

“…22,23 The level of care advised, the extent to which advice agreed with the caller's prior intention, care option availability and perceptions of risk also have an effect, with compliance seven times higher if the highest level of care is advised. 26 One paper 27 investigated the effect of English-language proficiency and found that those with limited proficiency were less likely (60.9%) to follow advice than those who were proficient (69.4%) and were more likely to have a higher level of care disposition.…”

“…40 A modelling study using nurse telephone triage advice and patient self-reported subsequent service use concluded that, overall, a triage service reduced health-care utilisation, except where a patient's original intended action had been to attend the ED and the nurse's advice was self-care. 26 Only two studies considered costs. A Swedish study estimated an overall health service cost saving of 3.3% for actual action compared with intended action after telephone triage and 12.7% if all nurse advice dispositions were followed.…”

“…A Swedish study estimated an overall health service cost saving of 3.3% for actual action compared with intended action after telephone triage and 12.7% if all nurse advice dispositions were followed. 26 A smaller study 28 of ED disposition review by GPs estimated a potential cost saving to EDs of £52,528 compared with GP employment costs of £41,416. However, the impact would be limited, as only 11% of telephone triage calls have an ED disposition.…”

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

“…Finally, callers may have chosen not to follow the recommendations because they lacked confidence in the telenurse or found the recommendations inappropriate. 20 36 37 …”