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King calls for ideas on national telephone service

5 March 2003 Media Statement

King calls for ideas on national telephone health service

Health Minister Annette King wants public feedback on a plan to give all New Zealanders access to a free 24-hour health information and advice phone service.

Healthline is a free telephone health service, staffed by registered nurses, who assess a caller's health needs and provide information and advice to help the caller decide on the health care they need.

Since May 2000, the Healthline service has been operating in four pilot sites in Northland, East Coast/Gisborne, Canterbury and the West Coast.

“An independent evaluation has shown that Healthline is an effective, safe way for New Zealanders to get expert health advice, which is particularly useful for disadvantaged groups and people in rural areas where can be difficult to access after-hours services,'' Ms King said.

“In the first two years in pilot areas Healthline received more than 79,000 calls, with 97 percent of the callers surveyed saying they were satisfied with their call.”

Ms King said the national expansion of Healthline is consistent with the New Zealand Health Strategy and the Primary Health Care Strategy. “A national Healthline service would promote the health and wellbeing of New Zealanders by directing consumers to the right care, at the right place, at the right time.''

Ms King said she wanted members of the public and health providers to take the opportunity to look at the plan, and make a submission to the Ministry of Health.

Issues raised in the Ministry of Health consultation document Developing a national Healthline service include how to effectively link Healthline and other national freephone health services.

Once community feedback on the proposed new national service has been received, along with information from the four pilot areas, the Ministry will develop a revised Healthline service specification and call for providers to tender for the service. The new national Healthline is likely to be operational during 2004.

Submissions close at 5pm on Friday, 11 April 2003. The submission booklet can be downloaded from the Ministry of Health website: www.moh.govt.nz or by
obtained by contacting the Ministry of Health.

Questions and Answers

Where does Healthline operate?
The four pilot services, currently provided by McKesson New Zealand, were launched in May 2000 Northland, East Coast/Gisborne, Canterbury and the West
Coast for two years.

Why were these areas chosen?
Because of their different populations, health needs and service access issues.

What are Healthline hours?
Healthline currently operates a 24-hour; 7 day a week free-phone service in the pilot areas, from a single call centre in Wellington.

Who staffs the call centre?
Registered nurses work at the centre. Using a computer programme and triage software, these nurses advise callers on the most appropriate course of action, given the symptoms they describe. The software incorporates a series of algorithms, or set of rules that specify the order and type of recommendations that may be used from the information the caller provides.
Telephone triage may include symptom assessment, counselling, home treatment advice, referral, information provision, disease management and crisis

How new is telephone triage?
The Healthline launch was preceded by extensive research on similar health phone-lines overseas. Telephone triage services have been operating in the US for the past 20 years, in the United Kingdom as NHS Direct, as well as Australia, South Africa, Scandinavia, France, Belgium and Portugal.
Five workshops were held in the pilot areas and in Wellington before the establishment of the pilot services. The workshops circulated information
about the proposal to invited provider organisations and consumer groups, and provided an opportunity for feedback to the Ministry on the proposals.

Who is Healthline for?
Healthline is accessible to everyone with a phone. It 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 operation 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 did Healthline receive in its first years of operation?
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 independent evaluation of the Healthline services?
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.

Where can I find a copy of the independent evaluation?
The Evaluation of the Healthline Service report is available on the Ministry of Health website: www.moh.govt.nz

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