Healthdirect study highlights lack of after-hours care

November 5, 2012, University of Western Australia

(Medical Xpress)—A study examining the appropriateness of referrals to the Royal Perth Hospital emergency department by the national telephone triage service healthdirect has spotlighted the lack of access to after-hours health care.

The study's authors, including Professor of Daniel Fatovich, of The University of Western Australia's Centre for Medical Research, and Dr Joseph Ng, and registrar in emergency medicine at RPH, found a significant number of people who attended the RPH emergency department after contact with healthdirect had done so despite advice to stay away.

Just over 52% of people who presented at the ED and were traced back to the healthdirect database had either been given advice on self-care or told to seek treatment from their GP or a non-emergency service.

Professor Fatovich said it could be argued that the healthdirect-referred patients in the study had low rates of compliance.  However, data showing a prominence of out-of-hours attendance by people in that group suggested it had more to do with the limited availability of after-hours health services.

"It's hard enough to access health services during the daytime hours let alone after hours," Professor Fatovich said.

The result might also reflect the inherent fallibility of a telephone consultation model.

"Really you need a face to face assessment, you can't diagnose over the phone," Professor Fatovich said.  "In any case patients will interpret the advice they're given in the context of their own perceptions and their own situation."

The study, in the November 5 edition of the , compared attendances by people who went to the RPH ED after contact with healthdirect with attendance by people who had self-referred, and people referred by .

Although the authors had hypothesised that healthdirect referrals would be more appropriate than self-referrals, they found instead that the two had similar rates, at 72.9% and 73.8% respectively.

GP referrals had the highest level of appropriateness, with 89.7% of referrals deemed appropriate by the definition used in the study.  GP referrals also had the highest rate of appropriate ambulance use, and the highest rate of admission.

The study, which used data from 2008 and 2009, was the first time the appropriateness of referrals from healthdirect had been thoroughly evaluated.

Professor Fatovich said while healthdirect was very highly rated by the community and got high satisfaction scores from those who used it, there was no evidence that it reduced demand on EDs - one of the arguments used to justify the cost of providing the service.

"The lay public needs and wants easy access to health information and advice and this is invaluable.  Many people see it as a lifeline, but to justify the cost of the service by saying this is going to reduce demand on EDs is not supported by any research.  What we say in the paper is that's a misplaced argument."

The authors wrote that such an argument perpetuated the myth that EDs are overrun with patients who could more appropriately receive care in a general practice setting.

"This is a simplistic explanation of the complex issue of ED overcrowding," they wrote.  "To date, it has been shown that telephone triage services have limited capacity to influence ED use or workload."

Professor Fatovich said the study showed people were very good at working out that they are seriously ill and require ED services, with self-referred patients showing the highest level of acuity and the only deaths amongst those studied.  It also showed those receiving GP referrals were more likely to be older patients, while those using healthdirect were more likely to be younger, and female.

Limitations of the study included that there was no gold standard definition of 'appropriateness'.  The results also may have limited external generalisability because they focused on adult referrals, even though parents calling for advice about children usually formed the major component of telephone triage services.

Healthdirect Australia is a free, 24-hour nationwide telephone triage service funded by State and Federal governments. It is staffed by registered nurses, although last year an after-hours GP helpline was added to the service.

Explore further: Wide variation in emergency service response to elderly falls patients

Related Stories

Wide variation in emergency service response to elderly falls patients

March 27, 2012
The ambulance service response to emergency calls for elderly falls patients varies widely across the UK, reveals research published online in Emergency Medicine Journal.

Wide variation in number of patients GPs refer with suspected cancer

July 31, 2012
Information published today by the National Cancer Intelligence Network (NCIN) reveals wide variation across England in the numbers of patients with suspected cancer that GP practices refer to secondary care.

Urgent assessment in emergency departments can reduce surgical decision time and overcrowding

August 8, 2011
The use of Acute Care Emergency Surgical Service (ACCESS) in emergency departments (EDs) can lead to significant reductions in key patient measures, such as length of stay, surgical decision-making time and "time-to-stretcher" ...

After 20 years, male and female GPs still practice differently

August 15, 2011
University of Sydney research has found female GPs see more female patients and younger patients and are more likely to consult on psychosocial issues than their male counterparts.

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.