Telephone triage in general practices: A written case scenario study in the Netherlands

Figures & data

Figure 1. Features of the healthcare system of the Netherlands.[4] ¹National Institute for Public Health and the Environment: Nationaal Kompas Volksgezondheid: http://www.nationaalkompas.nl. ²InEen: http://ineen.nl/wp-content/uploads/2015/11/Benchmarkbulletin_HAP_2014_def.pdf

Table 1. Characteristics of practice assistants and general practices (n = 973).

Background characteristics	%
Age in years, mean (range)	42.4 (20–64)
Sex
Female	100
Working hours per week, mean (range)	25.1 (4–42)
Working experience in years, mean (range)	13.3 (0–47)
Highest completed medical education
Practice assistant	88.3
Nurse	5.3
Other	6.4
Triage training
Qualified triagist	11.6
Other (e.g. internal course)	55.9
No	32.5
Is/was triagist at GP cooperative
Yes	5.4
In the past	7.6
No	87.0
Frequency of use triage tool
Mostly (> 75%)	4.1
Often (50–75%)	15.2
Sometimes (25–50%)	41.2
Seldomly (< 25%)	35.4
Never	4.1
Moment of use of triage tool
Usually	28.1
Only in doubt	62.3
In retrospect (to check)	14.0
As a reference work during training or study	13.8
Daily work meeting with GP
During (coffee) break	39.7
At a fixed time	37.7
In between seeing patients	33.2
Other	3.6
No	7.6
Assistant gives telephone advice
Yes	99.5
Authorization of advice
Mostly (> 75%)	37.1
Often (50–75%)	8.4
Sometimes (25–50%)	21.8
Seldom (< 25%)	18.1
Never	14.6
Practice size
Solo/duo practice (vs. more than two GPs)	46.9
Practice location
Urban area (vs. rural)	45.0

Table 2. Assessment of required care: Practice assistants versus reference standard (n = 2240 cases assessed by 474 practice assistants).

	Reference standard
Practice assistant	Direct help	GP <1 hour	GP <3 hours	GP No time pressure	Telephone advice	Total
Direct help	179	88	16	0	6	289
GP < 1 hour	55	228	61	3	6	353
GP < 3 hours	12	110	221	84	34	461
GP no time pressure	0	34	67	281	135	517
Telephone advice	1	10	9	85	515	620
Total	247	470	374	453	696	2240

Direct help: direct action and immediate warning of GP and send in ambulance if necessary; GP <1 hour: appointment for urgent consultation with GP within one hour; GP < 3 hours: appointment for consultation with GP within three hours the same day, GP no time pressure: appointment for consultation with GP without time pressure; telephone advice: telephone advice by assistant. Items in bold: agreement between practice assistant and reference standard; dark grey cells: over-estimation of required care by practice assistant; light grey cells: under-estimation of required care by practice assistant.

Table 3. Multiple regression analysis: Predictors of error rate in triage assessments (n = 418).

	Error rate triage assessments
	B (95% CI)	SE B	β
Step 1
Constant	0.412 (0.362–0.461)	0.025
Working experience (years)*	–0.003 (–0.006–0.000)	0.001	–0.101
Triage training:
No training (Ref)
Qualified triagist	0.047 (–0.031–0.125)	0.040	0.064
Other (e.g. internal course)	–0.022 (–0.074–0.031)	0.027	–0.045
Step 2
Constant	0.497 (0.374–0.621)	0.063
Working experience (years)*	–0.003 (–0.006–0.000)	0.001	–0.104
Triage training:
No training (Ref)
Qualified triagist	0.045 (–0.035–0.124)	0.041	0.061
Other (e.g. internal course)	–0.019 (–0.072–0.035)	0.027	–0.038
Frequency of use of triage tool	–0.012 (–0.041–0.018)	0.015	–0.039
Frequency of authorization of advice	0.000 (–0.013–0.013)	0.007	0.001
Daily work meeting assistant and GP:
No work meeting (Ref)
At a fixed time*	–0.059 (–0.118–0.000)	0.030	–0.119
In between patients	–0.040 (–0.096–0.015)	0.028	–0.076
During (coffee) break	–0.041 (–0.096–0.013)	0.028	–0.085

*p < 0.05. Influential cases (n = 2), respondents who assessed less than three case scenarios (n = 5), and respondents with missing values (n = 49) on the included variables were excluded from the analysis. R² = 0.019 for step 1, ΔR² = 0.013 for step 2.

Giesen P, Smits M, Huibers L, et al. Quality of after-hours primary care in the Netherlands: a narrative review. Ann Int Med. 2011;155:108–113.

 PubMed Web of Science ®Google Scholar