Table 1.
Summary of Utilization Outcomes in Remote Triage Studies
| Study design | Comparison | Results |
|---|---|---|
| Randomized | ||
| McKinstry, 200225 Individual-randomized | Face-to-face consultation (N = 188) vs telephone advice (N = 182) |
Number of subsequent primary care contacts, mean (SD) • 0.4 (0.7) vs 0.6 (0.8); difference − 0.2 (95% CI − 0.3 to 0.0) Number of subsequent emergency department contacts, mean (SD) N • 0.0 (0.1) vs 0.0 (0.2); difference 0.0 (95% CI − 0.1 to 0.0) |
| Campbell, 201421 Cluster-randomized | GP triage (N = 5171) vs nurse triage (N = 5648) vs usual care (N = 5572) |
Primary care contacts after index over 28-day follow-up period, mean (SD) • GP: 2.62 (2.62) • Nurse: 2.78 (1.5) • Usual care: 1.87 (1.3) Emergency department contacts after index over 28-day follow-up period, mean (SD) • GP:0.03 (0.19) • Nurse triage: 0.03 (0.22) • Usual care: 0.03 (0.21) |
| Richards, 200423 Cluster-randomized | Nurse triage (NHS Direct* N = 2260) vs usual practice (N = 2458) |
Mean number of practice consultation consultations per patient (95% CI) • 1.43 vs 1.37; Poisson regression†, 1.04 (0.94 to 1.15) Mean number of after-hours consultation per patient • 0.082 vs 0.077; Poisson regression†, 1.05 (0.72 to 1.52) Mean number of ED consultations per patient • 0.053 vs 0.047; Poisson regression†, 1.10 (0.79 to 1.54) |
| Cragg, 199727 Cluster-randomized | Commercial deputized physician (N = 1082) vs longitudinal general practice physicians (N = 1037) |
Use of primary care in 2 weeks after call; percent, (95% CI) • Practice doctors: 46.5 (42.1 to 50.6) vs deputizing doctors: 44.2 (40.2 to 48.3); p = 0.299 |
| Lattimer, 199826 Cluster-randomized | Nurse triage (N = 7184) vs usual practice (N = 7308) |
Attendance at ED unit within 3 days of call: • 412 (95% CI 374 to 452) vs 391‡ (equivalence limits 313 to 489) |
| Nonrandomized | ||
| Turner, 201322 Controlled before-after | Total number of NHS 111 calls N = 408,851 |
Monthly ED attendances after implementation of NHS 111; percent change, (95% CI) • − 0.1 (− 3.8 to 3.7) Percent change in monthly primary care utilization with NHS 111 • 2.5 (− 3.5 to 8.5) |
| Munro, 200028 Controlled before-after | Total number of NHS Direct calls N = 68,500 | In 3 NHS Direct areas, the estimated trend changed from 2% a month before NHS Direct to − 0.8% afterward (estimated relative change − 2.9% [95% CI − 4.2 to − 1.5%]), whereas in the 6 control cooperatives, the trend hardly changed, from 0.8% a month before to 0.9% afterward (relative change 0.1% [95% CI − 0.9 to 1.1%]) |
| Richards, 200224 Interrupted time-series | Nurse triage (N = 3452) vs usual practice (N = 1233) |
Emergency department visits within 1 month of initial management; mean, (SD) • 0.033 (0.19) vs. 0.010 (0.10) mean difference: 0.023 (0.16) Primary care visits within 1 month of initial management; mean, (SD) • 1.35 (1.85) vs 1.01 (1.4) mean difference: 0.34 |
*NHS Direct is the first generation of a national 24-h nurse-led telephone helpline in England
†The value of no effect for a Poisson regression is 1.00
‡Adjusted for difference in denominator
CI = confidence interval; ED = emergency department; GP = general practitioner; NHS = National Health Service; SD = standard deviation