This evaluation found the 24/7 National Coronavirus Helpline provided an efficient service that is highly valued by survey participants. Further, it positively influenced the care seeking behaviours of consumers, reducing unnecessary ED presentations and emergency services calls. Literature reporting service metrics of telephone health advice lines is scant, making it hard to benchmark the performance of this service against others. Consumers who called the helpline waited around 48 seconds before having their call answered, which is slightly higher than a previously reported study of a psychology-led COVID-19 telephone support line (mean 28 seconds)[9]. However, the number of calls received per day (mean 23 calls per day) was lower than that of the 24/7 National Coronavirus Helpline (mean 482 calls per day)[9]. Provision of data regarding the staffing levels would assist with making a clearer comparison [9]. Despite a slightly longer wait time when compared to that reported in Matthewson et al. [9], the service maintained high levels of consumer satisfaction and there were low abandonment rates (84% of survey responders were satisfied with time kept on hold). Given the difference in calls volumes between the two studies, it may be reasonable to expect a longer wait time. Further research is needed to understand the minimum standard wait time to avoid compromising consumer engagement and satisfaction.
Consumer satisfaction in relation to the service was high amongst survey respondents as reflected by a low call abandonment rate (4%) and most survey respondents (71%) agreeing that they were satisfied or highly satisfied with the helpline. Most respondents were also satisfied or very satisfied with access to the service (including call menus and pre-call information) (83%); time kept on hold (84%); answers to consumer questions (79%); advice provided (78%); and communication skills and support provided by the call handler (84%); all of which are important indicators for service quality and future service engagement. Wider evidence that specifically reports on satisfaction in relation to telephone health advice and triage lines is limited. Many studies that do make generalisations about consumer satisfaction are in relation to telehealth consultation and not telephone advice and triage phone lines, making comparison difficult [4, 5, 10, 11]. This is an important conceptual distinction as the two interventions are very different from one another. Telehealth consultations are usually delivered by a trained GP or Nurse and include full health assessments [4, 10, 11]. Sometimes these services are used to provide a prescription to consumers where appropriate [10]. Telephone advice and triage lines are generally staffed by non-clinicians (or a mix of clinical and non-clinical staff) and rely upon data input to help guide decision making [12, 13]. Advice provided in the latter is more generalised in nature and aimed to equip consumers with enough information to self-manage their care (when appropriate) or seek out appropriate avenues for further assessment and treatment. Despite the lack of clarity, there are some small studies that show links between satisfaction levels and consumer decision making [14, 15]. To support service quality outcomes, further research that measures consumer satisfaction in the context of telephone health advice and triage is needed. Literature reporting the efficacy and consumer satisfaction of such models should also take care to make important conceptual distinctions between the two interventions to ensure that appropriate comparisons can be made.
In addition to high levels of satisfaction, the 24/7 National Coronavirus Helpline facilitated survey participants to make choices that reduced pressure on the health system/services, as intended. This highlights the utility of such services in triaging people to appropriate levels of care. Some of the behaviour choice options are not present in both before and after calling the helpline as the questions were developed around the service provision. For example, agents answering calls were trained to direct consumers to search for a GP on the Healthdirect website if they did not have one/could not get into see their own. The main behaviours of interest were in the diversion of consumers who were low or medium risk of hospitalisation away from the hospitals and prevent unnecessary emergency service (000) calls. These behaviours potentially diverted pressure from overburdened tertiary settings to primary or self-care.
This may be explained by the helpline increasing participants’ self-efficacy in undertaking their own care and accessing the right level of care and support in their home [15]. A 2012 study surveyed consumers about their care decisions following teletriage advice found that callers with greater self-efficacy were 1.1 times more likely to report engaging in self-care [15]. In our study, there was a decrease in both hospital visits and people contacting emergency services, supporting the notion that the advice provided acted as an intervention to support self-efficacy in care decisions.
Providing telephone triage advice has been found to assist with strategies to manage demand for healthcare services, with studies showing high levels of compliance with directives for help-seeking behaviours [13, 16]. Results from this study provide further evidence in support of strategies applying telephone triage advice to manage demand. Although these are consumer self-reported measures, they provide an indication of the extent to which consumers follow telephone triage advice. In a study which linked telephone health advice to ED presentations, hospital admissions and medical consultation claims, levels of compliance were reported to be 68.6% (attend ED immediately), 64.6% (see a doctor), and 77.5% (self-care)[16]. Higher levels of compliance with the direction of self-care were also seen in a retrospective study on the United Kingdom National Health Service (NHS) 111 non-emergency medical helpline [13]. In their study including over 1.9 million patients, they found 49% of callers complied with advice given, with the highest compliance levels (81%) seen when directed to self-manage at home [13]. Given the reasonably high levels of compliance seen in other studies, particularly when directed to self-manage care, it is reasonable to assume that some difference was achieved through the helpline, although the reliability of the exact impact is not possible to determine.