Abstract
BackgroundNowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA) appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP.MethodsFor the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness.ResultsThe mean NTAA rate was 27.5% – ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48–1.76) and lower with increasing age (RR 0.96, CI 0.93–0.99, per ten years) or when the patient presented >2 problems (RR 0.65; CI 0.51–0.83). Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18–1.78) and lowest for chest pain (RR 0.18; CI 0.06–0.47). After correction for differences in case mix, significant variation in NTAA between nurses remained (p < 0.001). Return consultations after NTAA were higher after nightly calls (RR 1.23; CI 1.04–1.40). During first return consultations, the hospital referral rate after NTAA was 1.5% versus 3.8% for non-NTAA (difference -2.2%; CI -4.0 to -0.5).ConclusionImportant inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.
Highlights
Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care
There are currently more than 130 general practitioner (GP) cooperatives in the Netherlands, generally with 40 to 120 full-time participating GPs, which cover over 90% of the entire Dutch population and serve between 50,000 and 500,000 people
The proportions of presented problems that were handled through nurse telephone advice alone (NTAA) ranged from 5.4% for chest pain to 47.9% for earache
Summary
Nurses play a central role in telephone triage in Dutch out-of-hours primary care. While only very few Dutch GP cooperatives make (experimental) use of computerized telephone advice systems (TAS) [6], nationwide telephone nurses do have access to a broad set of written protocols for the most acute problems, developed by the Dutch College of General Practitioners. During their shift in the out-of-hours centre, GPs are subsequently expected to authorise the content of all telephone contacts handled by the nurses
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