Possible associations between callers’ degree-of-worry and their socioeconomic status when contacting out-of-hours services: a prospective cohort study

Abstract

Background Telephone triage within out-of-hours (OOH) services aims to ascertain the urgency of a caller’s medical condition in order to determine the correct type of health care needed, ensuring patient safety. To improve the triage process by increasing patient-centred communication, a triage tool has been developed, whereby callers are asked to rate their degree-of-worry (DOW) as a measure of self-evaluated urgency. Studies show that low socioeconomic status (SES), being single and non-Western ethnicity are associated to low self-rated health and high morbidity and these factors may also be associated with high DOW. The aim of this paper was to examine if low SES, being single and non-Western ethnicity were associated to high DOW of callers contacting OOH services. Methods A prospective cohort study design, at the OOH services for the Capital Region of Denmark. Over 2 weeks, 6869 of 38,787 callers met the inclusion criteria: ≥18 years, patients themselves or close relative/friend, reported DOW, had a valid personal identification number and gave informed consent. Callers were asked to report their DOW (1 = minimal worry to 5 = maximal worry), which was dichotomized into low (1–3) and high (4, 5) DOW and linked to data from electronical medical records and Statistics Denmark. Socioeconomic factors (education and annual household income), marital status and ethnicity were assessed in relation to DOW by logistic regression. Results High DOW was reported by 38.2% of the participants. Low SES (low educational level; OR 1.5, 95% CI 1.3–1.7 and low annual household income; 1.5, 1.3–1.6) was associated with high DOW and so too was being single; 1.2, 1.1–1.3 and of non-Western ethnicity; 2.9, 2.5–3.4. Conclusions Knowledge of the association of low SES, marital status as single and non-Western ethnicity with high DOW among callers to OOH services may give call handlers a better understanding of callers’ DOW. If this does not correspond to the call handler’s perception of urgency, this knowledge may further encourage patient-centred communication, aid the triage process and increase patient safety. A better understanding of socioeconomic variables and their relation to callers’ DOW gives direction for future research to improve telephone triage of OOH services.

How well do nurses know their patients? Agreement between patients' degree‐of‐worry and nurses' estimation of patients' degree‐of‐worry—An observational study

“…The scaled content of DOW lies along a continuum from seeking information to distress and fear of consequences in acute illness [7], and DOW shows moderate correlation to consequence, concern and emotions (in writing) measured with the Brief Illness Perception Questionnaire which builds on the common-sense model by Leventhal [10]. Furthermore, research shows that a high DOW is strongly associated with acute hospitalisation and that individuals of low socioeconomic status report higher DOW than those of high socioeconomic status [9,11]. Even though high DOW is associated with acute hospital admission and high DOW is associated with low socioeconomic status, individuals with low socioeconomic status often have to present multiple times before being referred to a face-to-face consultation and being hospitalised [11][12][13].…”

“…Furthermore, research shows that a high DOW is strongly associated with acute hospitalisation and that individuals of low socioeconomic status report higher DOW than those of high socioeconomic status [9,11]. Even though high DOW is associated with acute hospital admission and high DOW is associated with low socioeconomic status, individuals with low socioeconomic status often have to present multiple times before being referred to a face-to-face consultation and being hospitalised [11][12][13]. There are many possible explanations for this delay, for example, lower health literacy, presentation of problem to ambulance-or medical helpline services or interpersonal communication [14].…”