Patient decision making: Use of and adherence to telephone-based nurse triage recommendations

Objective. Health plans, employer groups, and medical providers offer telephone-based nurse triage services to provide ready access to medical advice and information to assist patients in making decisions about their medical needs. The purpose of this study is to assess patient adherence to nurse triage recommendations. Patients and Methods. The study includes data for members of an HMO located in a large metropolitan area who used the triage service during 1997 (n = 22,998). The nurse triage call data are linked with medical claims and encounter data to assess patient medical service utilization following a call to the triage service to assess triage adherence. The authors consider no use of medical services following a triage call with the recommendation to use self-care advice at home an indicator of adherence to this recommendation. Results. The percentage of callers who adhered to triage recommendations to use hospital emergency services, physician office services, or self-care advice was 79.2%, 57.4%, and 65.8%, respectively. Adherence varies somewhat by age. Conclusion. The reported adherence levels are lower than those obtained from self-reported data reported elsewhere. Given the inherent limitations of both types of data, actual telephone-based nurse triage adherence may lie between the 2 levels. Key words: adherence; telephone triage; telephone clinical assessments; patient decision making.