TY - JOUR T1 - Health system use and outcomes of urgently triaged callers to a nurse-managed telephone service for provincial health information after initiation of supplemental virtual physician assessment: a descriptive study JF - CMAJ Open JO - CMAJ SP - E459 LP - E465 DO - 10.9778/cmajo.20220196 VL - 11 IS - 3 AU - Kendall Ho AU - Riyad B. Abu-Laban AU - Kurtis Stewart AU - Ross Duncan AU - Frank X. Scheuermeyer AU - Lindsay Hedden AU - Helen Novak Lauscher AU - Sandra Sundhu AU - Rina Chadha AU - Jim Christenson AU - Eric Grafstein AU - Danielle C. Lavallee AU - Roy Purssell AU - John M. Tallon AU - Nancy Wood AU - Stirling Bryan Y1 - 2023/05/01 UR - http://www.cmajopen.ca/content/11/3/E459.abstract N2 - Background: British Columbia’s 8-1-1 telephone service connects callers with nurses for health care advice. As of Nov. 16, 2020, callers advised by a registered nurse to obtain in-person medical care can be subsequently referred to virtual physicians. We sought to determine health system use and outcomes of 8-1-1 callers urgently triaged by a nurse and subsequently assessed by a virtual physician.Methods: We identified callers referred to a virtual physician between Nov. 16, 2020, and Apr. 30, 2021. After assessment, virtual physicians assigned callers to 1 of 5 triage dispositions (i.e., go to emergency department [ED] now, see primary care provider within 24 hours, schedule an appointment with a health care provider, try home treatment, other). We linked relevant administrative databases to ascertain subsequent health care use and outcomes.Results: We identified 5937 encounters with virtual physicians involving 5886 8-1-1 callers. Virtual physicians advised 1546 callers (26.0%) to go to the ED immediately, of whom 971 (62.8%) had 1 or more ED visits within 24 hours. Virtual physicians advised 556 (9.4%) callers to seek primary care within 24 hours, of whom 132 (23.7%) had primary care billings within 24 hours. Virtual physicians advised 1773 (29.9%) callers to schedule an appointment with a health care provider, of whom 812 (45.8%) had primary care billings within 7 days. Virtual physicians advised 1834 (30.9%) callers to try a home treatment, of whom 892 (48.6%) had no health system encounters over the next 7 days. Eight (0.1%) callers died within 7 days of assessment with a virtual physician, 5 of whom were advised to go to the ED immediately. Fifty-four (2.9%) callers with a “try home treatment” disposition were admitted to hospital within 7 days of a virtual physician assessment, and no callers who were advised home treatment died.Interpretation: This Canadian study evaluated health service use and outcomes arising from the addition of virtual physicians to a provincial health information telephone service. Our findings suggest that supplementation of this service with an assessment from a virtual physician safely reduces the overall proportion of callers advised to seek urgent in-person visits. ER -