Abstract
Background: A regional 24/7 free telephonic nursing triage service including centralised bookings into general practice and community pharmacy “North Coast Health Connect” (~20,800 calls since service inception) is assessed from the perspective of service users, drawing on quantitative and qualitative data.
Approach: As part of a comprehensive embedded evaluation and quality improvement activity, people who called North Coast Health Connect are sent a text message to complete an electronic follow up experience survey designed to elicit their perceptions of the service in relation to improving primary care access. For this study we analyse responses obtained between 8 January 2024 and 6 November 2024 (n=480). We also conducted 13 semi-structured interviews with a purposive sample of survey respondents. Interviews sought to understand user experience and enablers and constraints to care access. Quantitative and qualitative data were analysed thematically and interpreted through Levesque’s framework of patient-centred access to health care.
Results: We identified three themes describing users’ experience of the service: 1) the importance of personal contact (friend/family/pharmacist/GP) as sources of information about the service 2) the high availability of the triage service as the main advantage perceived by users - allaying concerns about health (or providing recommendations about what level of care to seek) due to low availability of timely GP appointments in the region 3) users’ anticipated barriers to accessing recommended care, such as expectations of out-of-pocket costs, or perceived distance of GPs/other services was seen to influence whether or not the callers followed care recommendations given to them by the triage nurse. Where users were offered and took up the integrated booking appointments with GPs, this was highly valued.
Survey responses concurred with qualitative findings - people predominantly heard about the service via personal contact (comprising 46% of all sources mentioned) and 78% (375/480) of survey respondents indicated it was easy or very easy to follow triage instructions provided on the call, but reports of successful attendance at the recommended care varied by provider. Some 27% (133/480) survey respondents anticipated that costs of appointments at GP or specialists would limit them seeking recommended care in the future.
Implications: This study considers the effectiveness of a triage service with integrated bookings from user perspectives. It draws attention to the role of past healthcare experiences in shaping users’ expectations, and willingness to follow care recommendations provided to them by a triage nurse. Strengthening the service through targeted marketing and outreach to target groups who may not be linked into the networks in which the service is already known, should be considered. Triage nurses can increase the likelihood of their recommendations being followed by ensuring that users’ expectations and perceived barriers to following recommended care are identified and addressed.