Grant: Travel Awards - Institute Community Support

Objectives: Health help lines (HHL) were introduced by provincial health ministries to provide health information that could be used to make health care decisions and in turn decrease use of costly emergency departments (ED). The review assesses whether HHL decrease utilization of ED for non-urgent care in Canada. Approach: A comparison of HHL approaches and outcomes in Canada was conducted to identify gaps and limitations in the research related to whether HHL in Canada actually decrease use of ED; and identify the policy implications. Studies of provincial HHL were included if data collection occurred for a period of at least one year and if the evaluation included the number or percentage of calls triaged to the ED, number or percentage of callers who intended to use ED prior to the call, and or the number or percentage of callers who used the ED after calling the HHL. Results: Studies from British Columbia, Alberta, and New Brunswick met the criteria for review, but only the study from New Brunswick reports on the entire provincial program. All HHL are manned by registered nurses who used computer protocols to assess symptoms and triage callers to health services or self-care, and are available 24 hours a day - although used sparingly. Conservative protocols are associated with more callers being advised to attend ED. Pre-call intent, and triage disposition vary among the provinces, and ED use by all disposition groups is unavailable or limited by the fact that they are obtained from self-report surveys. Based on data currently available it is not possible to determine whether HHL decrease ED use due to incompleteness of the data. Conclusions: Comprehensive reviews of HHL that include pre-call intent, triage disposition, and utilization data from administrative sources are needed, and should include the number of non-urgent visits to ED before and after HHL implementation. Greater efforts are needed to target those who use ED and encourage them to use HHL.