title: Impact of standalone and embedded telephone triage systems on after hours primary medical care service utilisation and mix in Australia.
abstract: BACKGROUND
  The Australian government sponsored five local trials aimed at addressing problems in after hours (AH) primary medical care (PMC). The study's objective was to determine if the four trials, where telephone triage was the sole innovation, led to a reduction in AH service utilisation and change in service mix towards AH GP clinics. Changes in utilisation and mix of AH GP clinic and home visits, ED and ambulance use were monitored in the trial areas, and in a national sample to adjust for the effects of secular trend. Pre- and post-trial telephone surveys of two separate random samples of approximately 350 AH PMC user households in each area were conducted.
  
  
  RESULTS
  Some types of AH PMC use became more frequent in both of the standalone services using nurse-administered proprietary call centre software, which were aimed at better addressing population need (Statewide call centre; Regional call centre). Service use overall (95%CI: 1.03-1.83) and GP clinic use (95%CI: 1.07-2.00) increased in the metro area of the Statewide call centre and in GP clinic (95%CI: 1.04-2.14) and home visits (95%CI: 1.03-3.91) in the non-metro area of the Regional call centre. Service mix only changed in the non-metro area of the Regional call centre with increased contact in GP home visits (95%CI: 1.02-4.38). Levels of use remained unchanged in both embedded services using other than proprietary software, which were established to support the GP workforce (Deputising service; Local triage centre). Service mix only changed in the Deputising service with a change away from AH GP clinics in both contact (95%CI: 0.39-0.97) and frequency (95% CI: -2.12 - -0.7).
  
  
  CONCLUSIONS
  Bearing in mind limitations in estimating AH PMC utilisation levels and mix, it is concluded that the impacts of telephone triage were generally smaller in Australia than reported elsewhere. There were different impacts on levels of service utilisation and service mix in standalone call centres and embedded services. Impacts of telephone triage on service utilisation and mix are influenced by the type of telephone triage offered, the goals of the agency providing the service, as well as local factors.
authors.affiliation: Program Evaluation Unit, School of Population Health, University of Melbourne, 3010, Australia. d.dunt@unimelb.edu.au
authors.forename: David
authors.initials: D
authors.lastname: Dunt
authors.forename: Susan E
authors.initials: SE
authors.lastname: Day
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelaher
authors.forename: Michael
authors.initials: M
authors.lastname: Montalto