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Evaluating patient compliance with nurse advice line recommendations and the impact on healthcare costs.

OBJECTIVE
To explore the effect of telephone triage and advice lines in uninsured and managed care populations served by a safety net system and to document the relationship between the patient's initial plan for healthcare, the nurse recommendation, and the patient's subsequent healthcare action.


STUDY DESIGN
Prospective telephone survey.


PATIENTS AND METHODS
Of 1538 calls to a nurse advice line in a 28-day period, 710 (46%) callers were selected to be surveyed. Of those, 278 (39%) were surveyed by telephone within 7 days of their call to assess patient compliance with recommendations, the patient's actual healthcare actions, and their satisfaction with the service.


RESULTS
Patients' reported actions were classified as either (1) home care (46%), (2) clinic visit (27%), or (3) hospital visit (27%). Seventy percent of patients complied with nurse advice line recommendations. Most patient actions (68%) differed from their original healthcare plan, with many (46%) choosing a lower intensity of care. Changes from patients' original healthcare plans had a potential annual net savings of $322 249.


CONCLUSION
The simple act of calling a nurse triage and advice line corresponds with a change in the reported actions of uninsured and managed care patients and a potential reduction in costs to the safety net system providing their healthcare.