From direct attendance to telephone triage in an emergency primary healthcare service: An observational study

Objectives To describe how an intervention to limit direct attendance in an emergency primary healthcare service affected the contacts to the clinic and the level of care given, and which factors were associated with a change from direct attendance to telephone contact. Design Observational study. Setting Seven Norwegian emergency primary healthcare services. The telephone triage operators are primarily registered nurses. Participants Registered patient contacts to the services during 2007–2019. Interventions In 2013, one of the seven services made an intervention to limit direct attendances to the emergency primary healthcare clinic. Through an advertisement in a local newspaper, the public was encouraged to call in advance. Patients who still attended directly, were encouraged to call in advance next time. Measures We compared the proportions of direct attendance and telephone contact, and of consultation by a general practitioner and telephone consultation by an operator, before and after the intervention. We also compared the proportions of direct attendance regarding gender, age group, time of day and urgency level. Descriptive analyses and log binomial regression analyses were applied. Results There were 1 105 019 contacts to the seven services during the study period. The average proportion of direct attendance decreased from 68.7% (95% CI 68.4% to 68.9%) to 23.4% (95% CI 23.2% to 23.6%) in the service that carried out the intervention. Telephone consultation by an operator increased from 11.7% (95% CI 11.5% to 11.8%) to 29.2% (95% CI 28.9% to 29.5%) and medical consultation by a general practitioner decreased from 78.3% (95% CI 78.1% to 78.5%) to 57.0% (95% CI 56.7% to 57.3%). The youngest and the oldest age group and women had the largest decrease in direct attendance, by −81%, −74% and −71%, respectively. Conclusion The intervention influenced how the public contacted the service. Information campaigns on how to contact healthcare services should be implemented on a regular basis.publishedVersio

Vakttårnprosjektet. Epidemiologiske data frå legevakt. Samlerapport for 2022.

Koronapandemien gjorde at kontaktraten ved legevaktene steig kraftig i åra 2020 og 2021, men raten gjekk ned att i 2022, og var 380,7 pr. tusen innbyggjarar (426,6 pr. tusen i 2021). Variasjonen i reduksjonen er stor mellom vakttårna sidan pandemien vart handtert så ulikt i kommunane som vakttårna utøver tenester for. Mistanke om covid-19 gjaldt 8,1 prosent av kontaktane i 2022; prøvetaking av korona utgjorde 6,5 prosent av første tiltak. Det meste av dette var konsentrert til første kvartal av 2022. Kvar tredje kontakt med vakttårna fekk telefonkonsultasjon med sjukepleiar som første tiltak (32,3 prosent); 41,6 prosent konsultasjon lege. Pandemien gav endringar i responsratane og responsfordelingane, med særleg høg del grøn respons. Året 2022 normaliserte dette ein del. Grøn respons utgjorde 58,4 prosent; 32,7 prosent av kontaktane fekk gul respons; 9,0 prosent raud respons. Pandemien endra ikkje kjønnsfordelinga av kontaktane med vakttårna, men endra aldersfordelinga ein del, ved at gjennomsnittsalderen steig i 2020, men fall i 2021. I 2022 auka han litt att og var 37,4 år. Mengda kontakt med vakttårna i helga (laurdagar og sundagar) var relativt sett lågare under pandemien enn det vi har sett tidlegare, underforstått kontaktmengda var større enn vanleg på dei andre fem vekedagane. I 2022 auka kontaktmengda på sundagar og laurdagar att og 33,9 prosent av kontakt med vakttårna kom då. Inkluderer vi flyttbare helgedagar i dette, kom 36,5 prosent av kontakt med vakttårna 2022 i det som var helg. Direkte oppmøte ved legevaktene gjekk kraftig ned under koronapandemien, men auka litt att i 2022 og utgjorde 4,1 prosent av kontaktmåtane. Alta kommunale legevakt er no vakttårnet med størst del direkte oppmøte (6,4 prosent). Telefonisk kontakt frå pasient, pårørande eller omsorgsperson utgjorde meir enn tre av fire (78,4 prosent). Omtrent kvar tolvte kontakt med vakttårna var frå helsepersonell (8,8 prosent).publishedVersio

Adolescents living with HIV in Botswana: What contributes to an HIV positive adolescent thriving?

Background: HIV positive adolescents' well-being is becoming an increasingly important issue, as antiretroviral medications are contributing to more HIV positive children surviving into adolescence and adulthood. Sub-Saharan Africa has the world's highest HIV incidence, with about two thirds of the 34 million people infected worldwide, living in this region. Botswana has the second highest infection rate in the world, and the epidemic has left a large proportion of children and adolescents orphaned. Many of the adolescents living with HIV in Botswana today have been HIV positive since they were born, or contracted HIV as infants via breastfeeding. A large number of these have for a great part of their lives been unaware of their diagnosis, as their caregivers have kept it a secret. Previous studies have looked at different aspects of disclosure of HIV status to children and adolescents, HIV-stigma and the mental health of HIV positive children and adolescents. However, few studies have explored these issues from the adolescents' point of view, and the majority of the studies are conducted in developed countries. Furthermore, a lot of the existing literature has explored the negative aspects of living with HIV; few have evaluated HIV positive adolescents who are thriving. Objectives: Two objectives were addressed: Objective 1) what makes HIV positive adolescents thrive, in spite of a complex difficult life situation? The following research questions were identified and addressed: 1) what contributes to well-being in an HIV positive adolescent? -Are there any positive factors in his/her environment? 2) What is important for the adolescents in the disclosure process? 3) Are there any differences in coping before and after being disclosed to? 4) How do the adolescents deal with the stigma related to HIV? Objective 2) is there evidence in the participants' narratives that Sense of Coherence plays a role in positive coping? Theoretical framework: For this study a salutogenic approach was implemented, which views health in relation to what creates health rather than what causes disease. Salutogenesis encompasses two main components: Generalised Resistance Resources (GRR) and Sense of Coherense (SOC). By exploring what was positive and strengthening in an HIV positive adolescent's life, it was possible to identify pathways to what creates health and well-being among this group of adolescents. Methods: A phenomenological approach was implemented, facilitating the understanding of the lived experiences to seek a deeper explanation of a phenomenon. Data were collected in an urban and a rural area of Botswana, through focus group discussions, individual interviews and observations during a three month period from June to September 2011. 16 adolescents and three key personnel were enrolled in the study. Translators were used in all the interviews except one, to translate between English and the local language, Setswana. All the interviews were recorded and transcribed, and the Setswana recordings were translated into English. The data were analysed using directed content analysis, categorising ideas from the data into themes, based on the research questions. Permission to do the study was obtained from the required instances in Botswana and Norway, and informed consent was obtained from all the participants, and from caregivers of participants under the age of 18 years. Results..

Telephone counselling by nurses in Norwegian primary care out-of-hours services: a cross-sectional study

Background: The primary care out-of-hours (OOH) services in Norway are characterized by high contact rates by telephone. The telephone contacts are handled by local emergency medical communication centres (LEMCs), mainly staffed by registered nurses. When assessment by a medical doctor is not required, the nurse often handles the contact solely by nurse telephone counselling. Little is known about this group of contacts. Thus, the aim of this study was to investigate characteristics of encounters with the OOH services that are handled solely by nurse telephone counselling. Methods: Nurses recorded ICPC-2 reason for encounter (RFE) codes and patient characteristics of all patients who contacted six primary care OOH services in Norway during 2014. Descriptive statistics and frequency analyses were applied. Results: Of all telephone contacts (n = 61,441), 23% were handled solely by nurse counselling. Fever was the RFE most frequently handled (7.3% of all nurse advice), followed by abdominal pain, cough, ear pain and general symptoms. Among the youngest patients, 32% of the total telephone contacts were resolved by nurse advice compared with 17% in the oldest age group. At night, 31% of the total telephone contacts were resolved solely by nurse advice compared with 21% during the day shift and 23% in the evening. The share of nurse advice was higher on weekdays compared to weekends (mean share 25% versus 20% respectively). Conclusion: This study shows that nurses make a significant contribution to patient management in the Norwegian OOH services. The findings indicate which conditions nurses should be able to handle by telephone, which has implications for training and routines in the LEMCs. There is the potential for more nurse involvement in several of the RFEs with a currently low share of nurse counselling

The association between municipal pandemic response and COVID-19 contacts to emergency primary health care services: an observational study

Abstract Background Norwegian municipalities had diverse strategies for handling tasks related to the COVID-19 pandemic. The emergency primary health care services were involved to different extents. The aim of this study was to describe how contacts with the emergency primary health care service were affected by the pandemic, in terms of patient contacts related to COVID-19, prioritisation and first actions taken, and to analyse differences between the services. Methods In this observational study, patient contacts to seven emergency primary health care services, from January 2020 to June 2021, were analysed. Descriptive analyses were applied. Data on the seven services’ involvement in the municipal pandemic response, in relation to testing the inhabitants for COVID-19, were collected. Results There were 145 685 registered patient contacts within the study period. In total, 24% (n = 35,563) of the contacts were related to COVID-19, varying from 16 to 40% between the seven services. Of the COVID-19 related contacts, 96% (n = 34,069) were triaged to the lowest urgency level (range 76–99%) and 66% (n = 23,519) were patients contacting the services in order to be tested for COVID-19 (range 5–88%). The number of COVID-19 related contacts were unrelated to the number of confirmed COVID-19 cases among the inhabitants of the respective municipalities. The burden of COVID-19-related contacts mainly reflected the services’ involvement in COVID-19 testing as part of the municipal pandemic response. Conclusions During the COVID-19 pandemic, several of the emergency primary health care services were assigned new tasks, such as being part of the municipalities’ system for carrying out testing for COVID-19. This had a major impact on their activity level. In the preparation for future pandemics, it should be discussed to which extent such use of the emergency primary health care system is appropriate, as additional tasks might affect the services’ preparedness to provide urgent medical care among the inhabitants

Legevaktorganisering i Norge. Rapport fra Nasjonalt legevaktregister 2014

publishedVersio

Kompetanse i legevakt og legevaktsentral – implementering av akuttmedisinforskriften

På oppdrag fra Helsedirektoratet gjennomførte Nasjonalt kompetansesenter for legevaktmedisin i mars 2017 en spørreundersøkelse blant alle legevakter og legevaktsentraler i Norge. Formålet var å kartlegge kompetansen blant legevaktleger og operatører i legevaktsentraler med utgangspunkt i kravene i akuttmedisinforskriften.publishedVersio

Vakttårnprosjektet: Epidemiologiske data frå legevakt. Samlerapport for 2023

Året 2023 står fram som eit normalår i Vakttårnprosjektet etter at covid-19-pandemien gav stor pågang hos dei deltakande legevaktene i 2020 og 2021. Raten fall i 2022 (380,7 pr. tusen innbyggjarar), og gjorde det òg i 2023, til 330,4 kontaktar pr. tusen. Variasjonen mellom dei sju vakttårna er stor, men noko mindre enn i pandemiperioden. Høgast kontaktrate i 2023 hadde Austevoll legevakt, 637 pr. tusen innbyggjarar. Kvar tredje kontakt med vakttårna fekk telefonkonsultasjon med sjukepleiar som første tiltak (32,5 prosent), omtrent som i 2022; 47,9 prosent fekk konsultasjon lege, ein klar auke frå 2022. Igjen så ser vi endringar i responsfordelinga: Grøn respons utgjorde 53,7 prosent; 36,2 prosent av kontaktane fekk gul respons; 10,0 prosent raud respons. Delen grøn respons har med det minka; dei to andre har auka. Kjønnsfordelinga av kontaktane er som før, i overkant av femti prosent er kvinner (54,1 prosent i 2023). Aldersfordelinga endra seg ein del under pandemien. I 2023 steig kontaktane sin gjennomsnittsalder til 38,9 år, ein auke på 1,5 år sidan året før og det høgaste aldersgjennomsnittet nokon gong i Vakttårnprosjektet. Året 2023 gav ein klar nedgang i kontaktmengda i dei fem første vekedagane, og mengda auka relativt sett i helga, der 36,5 prosent av kontaktane i løpet av veka kom på laurdagar og sundagar. Ved å inkludere flyttbare helgedagar i dette, kom 40,0 prosent av kontaktane med vakttårna i 2023 i det som var helg. Direkte oppmøte ved legevaktene gjekk kraftig ned under koronapandemien, men auka litt att også i 2023, og utgjorde 5,8 prosent av kontaktmåtane. Legevakten i Arendal var i 2023 vakttårnet med størst del direkte oppmøte (6,9 prosent). Telefonisk kontakt frå pasient, pårørande eller omsorgsperson utgjorde omtrent akkurat tre av fire (75,8 prosent). Nær kvar tiande kontakt til vakttårna var frå helsepersonell (9,4 prosent), ein auke frå året før (8,8 prosent).Vakttårnprosjektet: Epidemiologiske data frå legevakt. Samlerapport for 2023publishedVersio

From direct attendance to telephone triage in an emergency primary healthcare service: An observational study

Objectives: To describe how an intervention to limit direct attendance in an emergency primary healthcare service affected the contacts to the clinic and the level of care given, and which factors were associated with a change from direct attendance to telephone contact. Design: Observational study. Setting: Seven Norwegian emergency primary healthcare services. The telephone triage operators are primarily registered nurses. Participants: Registered patient contacts to the services during 2007–2019. Interventions: In 2013, one of the seven services made an intervention to limit direct attendances to the emergency primary healthcare clinic. Through an advertisement in a local newspaper, the public was encouraged to call in advance. Patients who still attended directly, were encouraged to call in advance next time. Measures: We compared the proportions of direct attendance and telephone contact, and of consultation by a general practitioner and telephone consultation by an operator, before and after the intervention. We also compared the proportions of direct attendance regarding gender, age group, time of day and urgency level. Descriptive analyses and log binomial regression analyses were applied. Results: There were 1 105 019 contacts to the seven services during the study period. The average proportion of direct attendance decreased from 68.7% (95% CI 68.4% to 68.9%) to 23.4% (95% CI 23.2% to 23.6%) in the service that carried out the intervention. Telephone consultation by an operator increased from 11.7% (95% CI 11.5% to 11.8%) to 29.2% (95% CI 28.9% to 29.5%) and medical consultation by a general practitioner decreased from 78.3% (95% CI 78.1% to 78.5%) to 57.0% (95% CI 56.7% to 57.3%). The youngest and the oldest age group and women had the largest decrease in direct attendance, by −81%, −74% and −71%, respectively. Conclusion: The intervention influenced how the public contacted the service. Information campaigns on how to contact healthcare services should be implemented on a regular basis