Observational study of the implementation of telephone advice nursing in Sweden: did callers follow recommendations and did the rate of healthcare visits change?

OBJECTIVES: Telephone advice nursing is introduced in many countries with one key aim being a reduction of avoidable healthcare visits. The aim of this study was to explore whether callers to a telephone advice nursing service followed the telenurses’ recommendations, and whether there was a change in the level and trend of the rate of healthcare visits after the introduction of telephone advice nursing. DESIGN: Observational study. SETTING: Primary and secondary care in Jönköping Region, Sweden. PARTICIPANTS: Telephone advice nursing calls, 6:00–23:00, 2014–2015 (n=185 994) and outpatient healthcare visits 2012–2015 (n=6 877 266). PRIMARY OUTCOME: Proportion of callers who visited healthcare within the time period advised by the telenurse. SECONDARY OUTCOME: Change in level or trend of the overall rate of healthcare visits per 1000 persons and 4-week period after the introduction of telephone advice nursing, with subgroup analysis for primary and secondary care. RESULTS: 77% of callers who were recommended either to visit healthcare within 24 hours or to ‘wait and see’ followed the recommendations. There was no significant change in level (−5.15; 95% CI −15.80 to 5.50; p=0.349) or trend (−0.24; 95% CI −0.86 to 0.38; p=0.448) of the overall rate of visits per 1000 persons and 4-week period after the introduction of telephone advice nursing. For the rate of primary care visits, an increase in level (8.01; 95% CI 6.36 to 9.66; p<0.001) and trend (1.28; 95% CI 1.17 to 1.39; p<0.001) were observed. For the rate of secondary care visits, a decrease in level (−8.77, 95% CI −14.41 to −3.13; p=0.004) and trend (−1.03, 95% CI −1.35 to −0.71; p<0.001) were observed. CONCLUSIONS: The introduction of telephone advice nursing may have contributed to a shift in the rate of healthcare visits from secondary to primary care.