Sociodemographic and health-related determinants for making repeated calls to a medical helpline: a prospective cohort study

Danish primary care: a focus on general practice in the Danish healthcare system

Denmark is known for its good population health, largely attributable to its effective healthcare system. This analysis of the Danish primary healthcare system with focus on general practice describes the system's overall structure, function, and financing. Further, it reviews some of the recent developments in organization and decentralization from secondary to primary care. Finally, we discuss some of the key challenges that primary care faces and potential areas for improvement to ensure a sustainable Danish healthcare system of high quality.

Characteristics and triage in older citizens calling a semi-acute medical helpline in Denmark: a prospective cohort study

OBJECTIVES

To investigate baseline characteristics associated with older citizens calling the medical helpline 1813 (MH1813) in Denmark and how these baseline characteristics were associated with triage outcomes in a subset population of patients with high degree of worry (DOW).

SETTING

In the Capital Region of Denmark people with acute, non-life-threatening illnesses or injuries are triaged through a single-tier MH1813 for acute healthcare services.

PARTICIPANTS

Participants were gathered from a prospective cohort established between 24 January and 9 February 2017 who called the MH1813. Out of 11,413 citizens, 1525 (13.3%) were elderly (≥ 65 years). Callers' identification, age, sex, and contact with general practitioner (GP) prior to MH1813-call were collected from the medical helpline's records. Data were enriched using the callers' self-rated health, self-evaluated DOW, and registry data on comorbidities.

RESULTS

Forty-two percent of call issues were terminated without any further action. Among 882 triaged to a hospital face-to-face consultation, n = 315 (36%) were admitted and 2/3 discharged directly from the emergency department. Approx. one third of the most worried older callers have had a contact with their GP prior to the MH1813 call. A high level on Charlson Comorbidity Index and high DOW significantly increased risk of admission. Adjusted self-rated health was not significantly associated with admission within the subset group of older self-callers and high DOW. Men more often than women, were referred to face-to-face consultation (46% vs. 37%) and subsequent admission (23% vs. 18%), though potentially explained by a higher comorbidity level in men.

CONCLUSION

The MH1813 triage revealed that older callers were triaged to Face-to-face consultations if they had high DOW or were men representing a higher level of comorbidities than women. The patients' perspectives on being alone, loneliness, rejection of Face-to-face triage, and the re-transition dilemma, needs to be further investigated.

"I surely don't call for fun": experiences of being a "frequent caller" to the Danish emergency helpline

BACKGROUND

While most Danish citizens never or very rarely call the national emergency helpline, 1-1-2, a few citizens call very often. In this article, we attend to the often-unheard voices of frequent callers, exploring why these citizens call 1-1-2 and why they often do not feel helped.

METHODS

The article is based on a mixed-methods study on citizens in the Central Denmark Region who had called 1-1-2 five or more times during a period of six months in 2023. The study drew on call data, questionnaires, and telephone interviews. In this article, we focus on the 12 citizens who participated in a semi-structured telephone interview. The interviews were transcribed verbatim and coded twice. Through abductive analysis of the data, we found Desjarlais' concept of "struggling along" to be a useful theoretical lens.

RESULTS

We found that our study participants "struggled along" in life and that they called 1-1-2 when they could not cope with their health conditions and difficult life circumstances themselves, and when neither their social networks nor the welfare society could help them out. Furthermore, we found that the sense of disorientation and the fragmentation of experience that is characteristic of "struggling along" made it difficult for our study participants to communicate with the Emergency Medical Coordination Center (EMCC) that manages all health-related calls to 1-1-2. Finally, our analysis pointed to differences in how the goal of providing "the right help at the right time" was understood by citizens and by health professionals working within the EMCC of the Prehospital Emergency Medical Services.

CONCLUSIONS

Overall, our study adds to the very limited literature on the experiences of frequent callers to emergency medical helplines. It emphasizes that frequent callers are people who call for help because they continue to need help, and it points towards the necessity of developing alternative interventions to help this diverse group of people.

Correlation between illness perceptions and self-reported degree-of-worry in somatic ill patients in emergency care: a Danish cross-sectional study

OBJECTIVES

The study aimed to investigate the correlation between illness perceptions and self-reported degree-of-worry (DOW) in patients presenting to the emergency department with acute somatic illness.

DESIGN

A cross-sectional survey study collected data from a survey on DOW, the Brief-illness Perception Questionnaire (B-IPQ) and demographics.

SETTING

An emergency department at a university hospital in the Capital Region of Denmark.

PARTICIPANTS

944 patients (≥18 years) presenting to the emergency department with acute somatic illness. Data collection was conducted during day and evening shifts on weekdays from 13 January to 19 December 2020.

METHODS

Correlations between B-IPQ scores and DOW, including (1) the total B-IPQ score, (2) emotional representations (emotion and illness concern combined) and (3) the single items, respectively. Secondary analysis: linear relationships between the single B-IPQ items and DOW. Analyses included the variables sex, age, reason for contact, self-reported comorbidity, employment, highest educational attainment, cohabitation status and region of origin.

RESULTS

The study found moderate correlations between the total illness perceptions score and DOW of 0.47 (95% CI 0.42 to 0.52) and emotional representations and DOW of 0.57 (95% CI 0.52 to 0.61). Linear regression showed the largest and most significant changes in DOW with an increasing score of the B-IPQ items for consequence, illness concern and emotion.

CONCLUSION

Illness perceptions overall and perceptions of consequences of symptoms, illness concern and emotional representations are correlated with patients' DOW, with increasing DOW related to more negative illness perceptions. This finding contributes to insight into how illness perceptions are related to illness worry when presenting to the emergency department. Incorporating the novel DOW scale may aid triage and clinical encounters in the emergency department.

STUDY REGISTRATION

ClinicalTrails.gov reference: NCT04226040.

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

AIM

To assess the agreement between patients' self-reported degree-of-worry (DOW) and nurses' evaluation of patients' DOW.

DESIGN

An observational cohort study with patients and their primary nurses.

METHODS

Between 22 February and 27 March 2021, data collection among patients and their nurses in an emergency department was carried out. Patients ≥18 years, cognitively intact and Danish or English speaking were eligible to participate. Nurses regardless of seniority and gender were eligible for participation. The single-item degree-of-worry measure, 'how worried are you about the condition you are here today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried' as well as information on gender, age, co-morbidity, triage level and medical reason for encounter was collected from patients. The corresponding nurses were asked; 'how worried do you think your patient is about the condition he/she is there today on a scale from 1 to 10, where 1 is minimally worried and 10 is maximum worried?' Nurses also supplied data on gender, age, seniority as a Registered Nurse and in the ED. Agreement between patients' self-reported degree-of-worry and nurses' evaluation of patients' degree-of-worry was assessed with weighted Cohen's Kappa.

RESULTS

A total of 194 patient-nurse pairs were included for analysis. The agreement between patients' DOW and nurses' evaluation of patients' DOW categorised as DOWlow , DOWmiddle and DOWhigh was in total agreement in n = 85 pairs (43.8%) of the ratings, which corresponds to a weighted Cohen's Kappa of 0.19 (0.08-0.30; p < 0.001).

CONCLUSION

Nurses estimate of their patients' DOW was in very poor agreement. This indicates that nurses are not able to assess the patient's DOW to a satisfactory level. This result is troubling as it may have serious consequences for patient care as it indicates that the nurses do not know their patients' perspectives.

One for all or all for one? An integrative review of research on frequent callers

Objective

Telephone health services is an increasing and integral part of health care in several countries. Callers who call repeatedly, in the current study "frequent callers" are present in all kinds of healthcare services, often constitute a considerable proportion of the total amount of calls and are complicated to help. The aim was to provide a comprehensive overview of research on frequent callers at a variety of telephone health services.

Methods

An integrative literature review. Literature was searched for the period 2011-2020 in CINAHL Plus, MEDLINE, APA PsycArticles, APA PsycInfo, and PubMed, and resulted in the inclusion of 20 articles.

Results

Studies on frequent callers (FCs) were found in the context of emergency medical services, telephone helplines, primary healthcare, and specialist medicine clinics. Frequent calling was associated with psychiatric comorbidity, and the reasons for calling were often multifaceted.

Conclusion

The strategies suggested for handling calls involved an individual approach, which could be enabled through multidisciplinary work.

Innovation

The main findings indicate a need for a systematic approach and guidelines to enable optimal help for FCs. Cooperation among healthcare instances seems to contribute to a more individual care for FCs.

Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020

We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic.

Service use, clinical outcomes and user experience associated with urgent care services that use telephone-based digital triage: a systematic review

OBJECTIVE

To evaluate service use, clinical outcomes and user experience related to telephone-based digital triage in urgent care.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

Medline, Embase, CINAHL, Web of Science and Scopus were searched for literature published between 1 March 2000 and 1 April 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies of any design investigating patterns of triage advice, wider service use, clinical outcomes and user experience relating to telephone based digital triage in urgent care.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and conducted quality assessments using the mixed methods appraisal tool. Narrative synthesis was used to analyse findings.

RESULTS

Thirty-one studies were included, with the majority being UK based; most investigated nurse-led digital triage (n=26). Eight evaluated the impact on wider healthcare service use following digital triage implementation, typically reporting reduction or no change in service use. Six investigated patient level service use, showing mixed findings relating to patients' adherence with triage advice. Evaluation of clinical outcomes was limited. Four studies reported on hospitalisation rates of digitally triaged patients and highlighted potential triage errors where patients appeared to have not been given sufficiently high urgency advice. Overall, service users reported high levels of satisfaction, in studies of both clinician and non-clinician led digital triage, but with some dissatisfaction over the relevance and number of triage questions.

CONCLUSIONS

Further research is needed into patient level service use, including patients' adherence with triage advice and how this influences subsequent use of services. Further evaluation of clinical outcomes using larger datasets and comparison of different digital triage systems is needed to explore consistency and safety. The safety and effectiveness of non-clinician led digital triage also needs evaluation. Such evidence should contribute to improvement of digital triage tools and service delivery.

PROSPERO REGISTRATION NUMBER

CRD42020178500.

Associations between degree-of-worry, self-rated health and acute hospitalisation after contacting a medical helpline: a Danish prospective cohort study

OBJECTIVES

Self-rated health (SRH) is a strong predictor for healthcare utilisation among chronically ill patients. However, its association with acute hospitalisation is unclear. Individuals' perception of urgency in acute illness expressed as degree-of-worry (DOW) is however associated with acute hospitalisation. This study examines DOW and SRH, respectively, and their association with acute hospitalisation within 48 hours after calling a medical helpline.

DESIGN

A prospective cohort study.

SETTING

The Medical Helpline 1813 (MH1813) in the Capital Region of Denmark, Copenhagen.

PARTICIPANTS

Adult (≥18 years of age) patients and relatives/close friends calling the MH1813 between 24 January and 9 February 2017. A total of 6812 callers were included.

OUTCOME MEASURES

The primary outcome measure was acute hospitalisation. Callers rated their DOW (1=minimum worry, 5=maximum worry) and SRH (1=excellent, 5=poor). Covariates included age, sex, Charlson Comorbidity Score and reason for calling. Logistic regression was conducted to measure the associations in three models: (1) crude; (2) age-and-sex-adjusted; (3) full fitted model (age, sex, comorbidity, reason for calling, DOW/SRH).

RESULTS

Of 6812 callers, 492 (7.2%) were acutely hospitalised. Most callers rated their health as being excellent to good (65.3%) and 61% rated their worry to be low (DOW 1-3). Both the association between DOW and acute hospitalisation and SRH and acute hospitalisation indicated a dose-response relationship: DOW 1=ref, 3=1.8 (1.1;3.1), 5=3.5 (2.0;5.9) and SRH 1=ref, 3=0.8 (0.6;1.4), 5=1.6 (1.1;2.4). The association between DOW and acute hospitalisation decreased slightly, when further adjusting for SRH, whereas the estimates for SRH weakened markedly when including DOW.

CONCLUSIONS

DOW and poor SRH were associated with acute hospitalisation. However, DOW had a stronger association with hospitalisation than SRH. This suggests that DOW may capture acutely ill patients' perception of urgency better than SRH in relation to acute hospitalisation after calling a medical helpline.

TRIAL REGISTRATION NUMBER

NCT02979457.

An evaluation of service user experience, clinical outcomes and service use associated with urgent care services that utilise telephone-based digital triage: a systematic review protocol

BACKGROUND

Telephone-based digital triage is widely used by services that provide urgent care. This involves a call handler or clinician using a digital triage tool to generate algorithm-based care advice, based on a patient's symptoms. Advice typically takes the form of signposting within defined levels of urgency to specific services or self-care advice. Despite wide adoption, there is limited evaluation of its impact on service user experience, service use and clinical outcomes; no previous systematic reviews have focussed on services that utilise digital triage, and its impact on these outcome areas within urgent care. This review aims to address this need, particularly now that telephone-based digital triage is well established in healthcare delivery.

METHODS

Studies assessing the impact of telephone-based digital triage on service user experience, health care service use and clinical outcomes will be identified through searches conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus. Search terms using words relating to digital triage and urgent care settings (excluding in-hours general practice) will be used. The review will include all original study types including qualitative, quantitative and mixed methods studies; studies published in the last 20 years and studies published in English. Quality assessment of studies will be conducted using the Mixed Methods Appraisal Tool (MMAT); a narrative synthesis approach will be used to analyse and summarise findings.

DISCUSSION

This is the first systematic review to evaluate service user experience, service use and clinical outcomes related to the use of telephone-based digital triage in urgent care settings. It will evaluate evidence from studies of wide-ranging designs. The narrative synthesis approach will enable the integration of findings to provide new insights on service delivery. Models of urgent care continue to evolve rapidly, with the emergence of self-triage tools and national help lines. Findings from this review will be presented in a practical format that can feed into the design of digital triage tools, future service design and healthcare policy.

SYSTEMATIC REVIEW REGISTRATION

This systematic review is registered on the international database of prospectively registered systematic reviews in health and social care (PROSPERO 2020 CRD42020178500 ).