RT Journal Article SR Electronic 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 FD Canadian Medical Association SP E459 OP E465 DO 10.9778/cmajo.20220196 VO 11 IS 3 A1 Kendall Ho A1 Riyad B. Abu-Laban A1 Kurtis Stewart A1 Ross Duncan A1 Frank X. Scheuermeyer A1 Lindsay Hedden A1 Helen Novak Lauscher A1 Sandra Sundhu A1 Rina Chadha A1 Jim Christenson A1 Eric Grafstein A1 Danielle C. Lavallee A1 Roy Purssell A1 John M. Tallon A1 Nancy Wood A1 Stirling Bryan YR 2023 UL http://www.cmajopen.ca/content/11/3/E459.abstract AB 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.