Abstract
Introduction: In general practice, prescribing clinician shortages have reduced availability of short-notice in-person appointments, sometimes resulting in waits of several weeks for routine appointments. Teletriage enables patients' earlier access to care and reduces in-person workload by arranging time-appropriate, in-person appointments or managing some patient care remotely. While commonplace in general practice surgeries (GpS) worldwide and in Aotearoa, little research on teletriage effectiveness outcomes or the demographics of patients being teletriaged exists.
Aim: The aim of the study is to examine teletriage outcomes of patients in general practice requesting short-notice appointments within an effectiveness perspective and also analysing the demographic characteristics of patients who are teletriaged.
Method: A twenty working day quantitative retrospective approach examined nurse practitioner (Np) and registered nurse (RN) teletriage outcomes for a GpS patient cohort requesting same-day appointments. All eligible patients' records were retrospectively analysed, examining triage outcomes and demographic characteristics to provide insight to patient group preferences and equity issues.
Results: 607 requests were teletriaged. There was a prescriber shortage for the whole study period. Nps and RNs performed comparably in arranging appointments and managing healthcare remotely but differed in appointment timeframes and prescriber/non-prescriber appointments. Overall, 27.1% (164) of all calls were managed by teletriage-only (147) or referred elsewhere (17). Respiratory complaints were the most frequently cited health issue. There was no significant difference between patients reviewed in-person or via teletriage-only in terms of requesting appointments again for the same issue (repeat health requests). Māori represented significantly higher than non-Māori in requesting same-day appointments, most notably in younger Māori. Quintile 1 (least deprived) were most likely to request same-day appointments but were allocated less in-person appointments than the other quintiles.
Interpretation: Teletriage decision-making is complex due to constraints and limitations in appointment availability, but it provides a highly accessible health service. Both RNs and Nps contribute to teletriage. Māori differ to non-Māori in their requests of same-day appointments.
Conclusion: Teletriage delivers effectiveness and quality in managing patient care need especially in this climate of prescriber shortages. Nearly a quarter of patients were managed without in-person appointments, and they performed similarly in terms of repeat health requests. RNs and Nps were comparable in teletriage outcomes but varied in the types and timeframes of in-person appointments. Collaborative teletriage sessions (both RNs and Nps) brought additional effectiveness for RN clinical support. There was an equity perspective to patient demographics, with allocation of in-person appointments favouring Māori, younger people and more deprived quintiles.