After-hours telephone triage and advice in private and nonprivate pediatric populations

Objectives: To compare the content of after-hours medical triage and advice calls regarding private practice patients vs nonprivate practice patients and to assess caregiver compliance with advice resulting from these calls. Design: Survey of after-hours medical triage and advice calls during a 2-we ek period (September 1 through 15, 1996). Setting: Three private practices (serving approximately 24 000 patients) an d 1 urban hospital-based, nonprivate practice (serving approximately 12 000 patients). Subjects: After-hours medical triage and advice calls from caregivers of pa tients receiving their primary care in these settings. Main Outcome Measure: Compliance with recommended emergency department (ED) or office visit referrals. Results: A total of 286 calls regarding private practice patients and 377 c alls regarding nonprivate practice patients were received (P<.001). Eighty- one calls were referred by the nurse directly to the physician. Fifty-nine private practice patients and 59 nonprivate practice patients were referred to the ED. Caregivers of 94 private practice patients and 132 nonprivate p ractice patients were given home treatment advice. Appointments to be seen at their primary care source were given for 78 private practice patients an d 160 nonprivate practice patients. Nonprivate practice patients were more likely to be referred for office care (P=.005); private practice patients w ere more likely to be referred to the ED (P=.01). Compliance with ED referr als was 42% for patients of nonprivate practice and 46% for private practic e; for office visit referrals, compliance a as 64% for nonprivate practice and 69% private practice patients (P=.71 for compliance with ED referrals a nd P=.40 for compliance with office referrals). Conclusions: Compliance with recommended physician encounters was not signi ficantly different (and lower than expected) in both groups of patients. Pr ivate practice patients are more likely to be referred to the ED. Calls for nonprivate practice patients are more frequent and these patients are more likely to be referred to their primary care source. This difference may be due to caregivers of patients from nonprivate practices seeking advice for less serious conditions. Physicians should address telephone medicine with caregivers proactively during health maintenance visits.