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Patient intention and self-reported compliance in relation to emergency department attendance after using an after
Rosemary McKenzie1, David Dunt2, Allison Yates2
1Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia. r.mckenzie@unimelb.edu.au.
Objective:
To determine ED attendance and compliance with GP advice following a call to an after hours telephone triage and advice service.
Methods:
A descriptive study of users' of an after hours helpline self-reported ED attendance and compliance with GP recommendation, based on routinely collected service data and telephone survey results for 2783 callers in 2011-2012. The outcome measure was self-reported health service utilisation following advice from a GP on an after hours helpline.
Results:
One-third of the sample - 934 callers - intended to visit the ED. Of these, 504 (54%, 95% CI 50.7%-57.2%) reported taking other less urgent options. The GP assessment confirmed the original intention for 224 callers (24%, 95% CI 21.2%-26.9%). However, 151 patients (16%, 95% CI 13.8%-18.6%) did attend the ED as they had originally intended despite the GP's recommendation to seek less serious care, whereas a further 55 patients (6%, 95% CI 4.4%-7.6%) assessed by the GP as requiring ED care chose a less serious option. Fifty-five per cent of all callers who attended ED did not intend to visit the ED prior to their call. The overall net result was a small reduction in ED attendance compared with original intentions.
Conclusion:
An after hours GP helpline may divert some callers intending to go to the ED to other care. However, patient non-compliance may limit the capacity of telephone triage and advice service to reduce demand for ED. Further research is needed to better understand the effect of the service.
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