Use of video in telephone triage in out-of-hours primary care: a register-based study (Preprint)

Abstract

Out-of-hours primary care (OOH-PC) is challenged by high workload, workforce shortage, and long waiting and transportation time for patients. Use of video enables triage professionals to visually assess the patients, potentially ending more contacts by telephone instead of referring patients to more resource-demanding clinic consultations or home visits. Thereby, video use may help reduce the workload in OOH-PC.

This study aimed to investigate video use in telephone contacts to OOH-PC in Denmark by studying usage rate, and potential associations between video use and patient- and contact-related characteristics and between video use and triage outcomes and follow-up contacts. We hypothesized that video use could serve to reduce the workload in OOH-PC.

This register-based study included all telephone contacts to OOH-PC in four of the five Danish regions from 15 March 2020 to 1 December 2021. We linked data from the OOH-PC electronic registration systems to national registers and identified telephone contacts with video use (video contact) and without video use (telephone contact). Calculating crude and adjusted incidence rate ratios (adj. IRR), we investigated the association between patient- and contact-related characteristics and video contacts and measured the frequency of different triage outcomes and follow-up contacts after video contact compared to telephone contact.

Of 2,900,566 identified telephone contacts to OOH-PC, 9.49% were conducted as video contacts. The frequency of video contacts was unevenly distributed across patient- and contact-related characteristics; it was used more often for employed young patients without comorbidities who contacted OOH-PC at more than four hours before the opening hours of daytime general practice. Compared to telephone contacts, significantly more video contacts ended with advice and self-care (adj. IRR=1.21, 95%CI=1.21-1.21) and no follow-up contact (adj. IRR=1.08, 95%CI=1.08-1.09).

This study supports our hypothesis that video use in telephone triage could reduce the workload in OOH-PC. Video use lowered the frequency of referrals to a clinic consultation or a home visit and also lowered the frequency of follow-up contacts. However, the results may be masked by confounding by indication.