Healthline A Success
26 June 2002
HEALTHLINE, the free 24-hour health information and advice line, has been judged a success in a comprehensive evaluation of the service, Ministry of Health spokesman Dr Colin Feek said today.
"The evaluation, made public today, judged that Healthline successfully provides New Zealanders with a confidential, reliable and consistent source of advice on health care 24 hours a day."
"Healthline offers an effective and safe way for New Zealanders to get expert health advice. It couples the knowledge and skills of experienced health professionals with sophisticated technology to guide people to the most appropriate form of care."
Healthline has been piloted in Gisborne/East Coast, Canterbury, the West Coast and Northland since May 2000 at a total cost of $7.5 million. It was evaluated by BRC Marketing and Social Research, with Te Pumanawa Hauora from Massey University.
"Nearly all callers surveyed (97 percent) said they were very satisfied or satisfied with their call to Healthline and 98 per cent reported they would use the service again. Two percent of callers said they were dissatisfied and one percent said they were neither satisfied or dissatisfied."
The BRC evaluation also found that most callers (71 percent) were advised by Healthline to take an alternative course of action from their pre-call intent. For example 10 percent of callers were planning to go to an Emergency Department before calling, but of these only 28 percent were advised to do so. Most were advised to see a GP immediately (34 percent) or how to care for themselves (43 percent).
The evaluation showed health providers in the regions where Healthline was piloted were largely supportive of the telephone service.
"The majority of providers said the referrals they have received from the service were appropriate and they consider Healthline to be complementary to their service."
Dr Feek said two expert groups had audited Healthline for clinical safety, and made a number of recommendations to ensure the ongoing safety of the service. The Ministry of Health and Healthline are working together to implement those recommendations.
"Healthline will continue in the pilot areas for a further year. During this time we will give the Minister of Health our recommendations on whether the service continues, and whether it is expanded to other regions."
The report can be viewed online at : www.moh.govt.nz/whatsnew.html
For more information contact: Marama Ellis Ministry of Health Media Advisor (04) 496 2o67, 025 802 622 http://www.moh.govt.nz.html
Who is Healthline for? Healthline is accessible to all people in the four pilot areas, 24 hours a day. Healthline provides: an assessment of medical problems with advice on the most appropriate level of treatment and a recommended timeframe for doing so advice on selfcare and symptom management advice on the prevention of illness health information, for example information about diseases information about availability and location of services referral connection to other emergency services
What happens during a call? Once connected the health professional will talk the caller through their symptoms, discount those that don't apply and through a process of elimination arrive at an assessment of how serious the symptoms are, the appropriate place to seek help and a timeframe within which to do so.
The advice dispensed may range from "an ice-pack and a lie-down" through to "see your GP within 24 hours" to "we're ordering an ambulance for you right now."
How safe is it? There's an in-built safety mechanism: the questions asked by the health professional are structured to eliminate the most serious possibilities first. They're set out in a software package which prompts the health professional without directing them. If at any stage professional training or instinct tells the Healthline health professional to override the software, then they will do so, under standard operationg procedures. Any decision to override the software has to be fully documented by the health professional and is reviewed the following day by team leaders.
This is not computer diagnosis. One example would be the caller with back pain which, in a worst case scenario could mean aortic dissection. This is a very serious condition caused when the main artery to the trunk and legs leaks or splits, causing tissue damage and pain. The Healthline health professional will check for this possibility first. Once eliminated he or she will then work through less serious possibilities.
How many calls has Healthline received? From May 2000 to the end of April 2002 Healthline received 79,254 calls.
How long is an average call? The average call to Healthline lasts 10 minutes.
What were the most common symptoms that people rang in about? The most common adult symptom people rang in about was abdominal pain. For children, the most common symptom people rang in about was vomiting.
Who carried out the evaluation? BRC Marketing and Social Research, and Te Pumanawa Hauora, Massey University.
BRC is both a specialist market research company and a social research agency. It has extensive experience in public sector research, much of which is within the health sector and programme evaluation related.
Te Pumanawa Hauora is a Maori Health Research Centre located within a School of Maori Studies, Massey University. It has considerable experience undertaking Maori health research and has completed numerous service evaluations, together with policy-related research and research from a Maori population perspective.
What else did the evaluation find? Most callers were women, or adults calling on behalf of their children. The majority of calls (78 percent) were from people who relayed symptoms. Other calls were from people who wanted general information. Most of the calls (69 percent) were made out of normal business hours (8am-5.30pm Monday to Friday). Most callers (69 percent) did what they were advised by Healthline staff. When callers didn't follow advice it was found to be because the symptoms in question had abated. 97 percent of callers said they were very satisfied or satisfied with their call to Healthline and only five formal complaints were laid. The Healthline provider managed these through to a satisfactory conclusion.
Didn't the evaluation include an audit for clinical safety? The Healthline service was audited for clinical safety by the Department of General Practice, Wellington School of Medicine and Health Sciences, and the School of Health Sciences, Massey University
The School of Health Sciences concluded that the service is a safe and effective clinical advisory service that operates in a manner consistent with New Zealand Nursing Council Guidelines.
Both audit teams found the Healthline service has operated at least as safely to date as similar overseas telephone services. They also found the Healthline service has the potential to provide a valuable and safe service and noted the following recommendations.
Healthline staff be alert to inconsistencies in caller histories Healthline staff address the issue that there are different risk factors for different ethnic groups particularly Maori, and show how the Healthline system has responded to the needs of Maori. Healthline staff be encouraged to use critical, reflective and clinical analysis to amend decisions where necessary Healthline establish procedures to enable staff to deal with medication-related enquiries Healthline staff be selected with particular regard to prior clinical experience in a primary care setting Ensuring Healthline staff accurately record clinical information.