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Nurse-led telephone advice line a serious failure, despite government spin
Despite government media releases to the contrary, the National Health Call Centre Network (healthdirect Australia) is dismally failing its reported aim of “helping to ease demand on emergency wards and general practice”, according to an editorial in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.
Established as a nurse-led national telephone triage service in 2006 with an initial budget of $176.4 million over five years, it was extended in July 2011 to include general practitioner support with an additional cost of $50 million over three years.
There is no evidence to support the government’s claims of benefit, said lead author of the editorial, Professor Yusuf Nagree, professor of emergency medicine at the University of Western Australia.
“In fact, the evidence is to the contrary. Unfortunately, an enduring myth is that EDs are over-run with patients who could have received care in a general practice setting and policies have been made based on this invalid assumption.
“Such policy initiatives have included stand-alone GP casualties, co-located GP clinics with EDs, GP Super Clinics and nurse walk-in-centres co-located with an ED.
“Formal studies to determine the effects of such initiatives are rare, although a recent review found that there was no evidence that they reduced ED demand.”
Advice prepared for Australian Health Ministers prior to the introduction of healthdirect Australia, stated that “direct evidence that call centres have reduced unnecessary demands on emergency departments, along with the costs and possibly the effectiveness of treatment of those cases where emergency treatment is appropriate, is weak and patchy”.
According to Professor Nagree, “despite the government’s own advice that there is no good evidence that call centres reduce ED demand, the government continues to misrepresent this in publicity of the after-hours GP helpline.”
Access block, not low acuity patients, is the key driver of ED over-crowding, staff stress, patient distress and increased mortality and morbidity, he said.
“Telephone lines have not been shown to reduce ED pressures,” he said.
“Addressing access block by providing funding for an increase in hospital beds along with innovative ways of managing patients needing domiciliary care, and better support for these patients in the community setting will have the greatest positive effect on EDs and patient outcomes.”
He said the Rural Doctors’ Association has calculated that it costs the taxpayer approximately $1000 for each person the after-hours GP helpline tells not to attend an ED.
“This is a very large amount, more than the marginal cost of providing treatment to these patients in the ED.
“It is very likely to be more effective and cost efficient to allow this small number of patients to attend the ED rather than spend over $200 million to ineffectively attempt to divert these patients to alternative care with a strategy that has not worked anywhere else in the world.
“The government must stop misleading the public about the effect of healthdirect Australia and the after-hours GP helpline on ED pressures, Professor Nagree said.