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Telephone advice no substitute for GP care

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Health advice hotlines and triage call centres do not relieve the pressure on hospital emergency departments and should not be used as a cut-priced approach to quality care, the AMA has said.

The AMA has sounded a warning on the proliferation of telephone triage services and call centres, saying that many have been set up to reduce demand on hospital emergency departments despite a paucity of evidence to back up the theory and persistent doubts about their cost effectiveness.

A number of services including healthdirect Australia (established by the Council of Australian Governments) and Medibank Private’s Mi Health hotline, have been established in recent years, ostensibly to improve access to health care advice and divert less urgent cases from emergency departments.

But AMA Vice President Dr Stephen Parnis said, while their might be a limited role for such services, they were no substitute for high-quality after-hours GP services.

In an updated Position Statement, Call Centre Triage and Advice Services, released earlier this month, the AMA was scathing about the motives of governments in backing such services, arguing that they often acted in ignorance.

“The focus on call centres as a solution to access to medical advice tends to be politically rather than need driven,” it said. “Low-acuity presentation rates to emergency departments have remained essentially constant and there is no support for the myth that GP-style patients are imposing significant pressure on hospitals compared to more urgent triage categories.”

Dr Parnis said the evidence to support the effectiveness of triage call centres was simply not there.

“There is a paucity of independent evidence regarding the cost effectiveness of call centre advice and triage services,” Dr Parnis said. “But there is good evidence that they are ineffective in managing the demand for emergency department services, a reason that is often given for the creation of such services.”

Part of the reason, the AMA said, was that they are not effective in screening patients.

“There is evidence to show that referrals to the ED by the national health call centre network healthdirect Australia, are no more appropriate than self-referrals, and less appropriate than GP referrals,” the Association said, adding that the problem was exacerbated by inadequate support for after-hours GP services.

“Evidence shows that patients often attend the ED despite a contrary recommendation by the call centre. This in part may be due to difficulty accessing after-hours health services,” the AMA said.

Dr Parnis said triage call centres could play a useful role, but only as part of an integrated GP out-of-hours service, especially in rural areas, where access to medical services can be limited.

He said that in order to operate safely and effectively, such services needed to have robust information and quality assurance systems in place.

To ensure continuity of care, call centres needed to ensure GPs were promptly informed when one of their patients called to seek advice, Dr Parnis said.

He said such services also needed to keep an up-to-date and comprehensive directory of practitioners so that operators could advise patients on locally available after-hours medical care.

But, perhaps most important, Dr Parnis said telephone triage services and help lines must be subject to regular quality assurance audits, and be staffed by doctors with an appropriate level of experience and hold a fellowship of the Royal Australian College of General Practitioners, the Australian College of Rural and Remote Medicine, or be recognised in the specialty of general practice by the Medical Board of Australia.

The Position Statement can be viewed at position-statement/call-centre-triage-and-advice-services-2004-revised-2014 

Adrian Rollins