75 Triage of elderly citizens calling a danish medical helpline

Abstract

Aim

Symptom description and degree-of-worry (DOW) by elderly contacting a medical helpline are poorly described.¹ Several diagnoses may be associated with preventable admissions for elderly citizens,² and increased risk of over-and-under-triage.³ We aimed to investigate how symptoms and worry are described by elderly citizens (age 65 and older) when they call a medical hotline.

Method

A mixed method design on data gathered from a three-week 2017 cohort, where callers rated their DOW on a 1–5 scale. A sub-cohort of 65+years was used. The National Patient Register gave data on admissions. Calls made by the patients (patient-caller) was included for the qualitative analysis (n=90).

Results

A total of 1530 acutely ill or injured elderly called the medical helpline. n=755 (50%) were patient-callers and n=364 (48%) of these had a high DOW. Of all patient-callers n=216 (28.6%) were triaged to face-to-face consultation and n=73 (9.7%) were subsequently admitted. The preliminary qualitative analysis led to the hypothesis that patient-callers often expressed exacerbation of chronic diseases (which are part of the preventable admission) and often lived alone. Those that were not triaged to face-to-face consultation were frequently offered one, but rejected because of the obstacles of leaving their home. The majority of patient-callers triaged to face-to-face consultation expressed that their general practitioner was not able to help them.

Conclusion

The majority of the elderly patient-callers was very worried and lived alone. Most of the calls concerned exacerbation of a chronic condition and most of the symptoms fitted the described preventable admission diagnoses.

References

• . Gamst-Jensen H, et al. Self-rated worry predicts hospitalisation in out-of-hours services telephone triage. Copenhagen; 2018. (abstact, not published).

• . KL. Regions of Denmark, Ministry of Finance and Ministry of Health, 2016; Indblik i sundhedsvæsenets resultater 2016, Report published by Ministry of Health. Avaliable at [cited 2018 Jan 12] http://www.sum.dk/~/media/Filer – Publikationer_i_pdf/2016/Indblik-i-sundhedsvaesenets-resultater-maj-2016/Indblik-i-sundhedsvaesenets-resultater-maj-2016.pdf

• . Gamst-Jensen H, Lippert FK, Egerod I. Under-triage in telephone consultation is related to non-normative symptom description and interpersonal communication: A mixed methods study. Scand J Trauma Resusc Emerg Med2017December 15;25(1):52.

Conflict of interest

None

Funding

None