Impact of telephone triage on medical service use: implications for rural and remote areas

Lack of ready access to health services is a continuing problem for the one-quarter of northern Ontario residents who live in non-urban areas. Teletriage has been proposed to help reduce medically unnecessary visits and thus free-up available resources. A mail survey obtained information about patients' use of teletriage and other health care services, as well as socioeconomic and demographic characteristics. Survey data (n = 2389) were used to determine the impact of teletriage on health service use by asking about the patient's intended use of health care service (intent), the service advised by the nurse (advice), and the actual health service used by the patient (action). Responses were compared among geographic categories based on commuter flows to urban areas in northern Ontario. Survey responses suggest that teletriage may have decreased visits to emergency departments relative to patient intent, and this effect appears to be stronger in communities with weak or no commuter flows (intent = 54%, action = 41%) than in urban areas (intent = 39%, action = 33%). Visits to physicians' offices or clinics may have increased relative to patient intent, but only for non-urban areas (intent = 16%, action = 21% to 23%) with strong, moderate, weak, or no commuter flows. Very little difference was found among geographic categories for calls or visits to other health care providers (overall: intent = 17%, action = 11%) or for informal care (self-care and care for others) (overall: intent = 16%, action = 29%). Results should be interpreted carefully, as there was evidence of selection and social desirability bias.