811 evaluation inconclusive about whether telehealth service is worth its cost

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Nova Scotians who use 811 are generally happy with the service, but a consultant’s report about the provincially-funded health advice line and website was unable to conclude whether it’s worth the money.

In its 90-page report, Davis Pier Consulting repeatedly noted the difficulty in determining whether people who called 811 actually followed the advice offered by the registered nurses and how hard it was to quantify how many people were diverted from a doctor or emergency department visit as a result of that conversation.

“It is hard to estimate cost savings to an emergency department since it is operating regardless of whether 811 sends patients there or not,” the $42,000 report noted.

In 2019-20, 811’s budget was $5.45 million.

What researchers could determine was that the doctors, nurses and paramedics it surveyed weren’t entirely sold on the usefulness of 811, which was established 10 years ago.

Dr. Todd Howlett is 811’s medical director. (Jean Laroche/CBC)

Asked whether they would recommend 811 as a “source of accurate information,” only 48 per cent of the 365 practitioners agreed they would. When it came to doctors, roughly 60 per cent said they would not.

Nearly 80 per cent of physicians and 60 per cent of paramedics disagreed or strongly disagreed with recommending it to patients.

“It was clear there was no consensus on the value of 811 from the groups engaged,” said the report.

In general, women make up two-thirds of the callers to 811. By far, most people call regarding a problem with an infant or child, and most calls take place outside normal business hours when doctors’ offices and clinics are closed.

‘Worth the money,’ says 811 director

The Department of Health released the 2018 report on Tuesday after officials representing 811 appeared before the legislature’s standing committee on health.

“I think it’s worth the money,” Dr. Todd Howlett, 811’s medical director, told reporters after the committee appearance on Tuesday.

“Consistently, we have very high user satisfaction. I think it’s over 90 per cent of people who are satisfied or very satisfied by using the program.”

He said 811’s effectiveness goes beyond its “tele-triage” service. Callers are also referred to smoking-cessation and problem-gambling programs.

Health Minister Randy Delorey says the Health Department is discussing ways to more accurately explain 811’s purpose to health-care providers. (CBC)

Since 2010-11, the first full year of the service, the number of callers has gone from 88,492 to a high of 140,591 in 2013-14. In 2018-19, there were 90,924 callers.

Health Minister Randy Delorey said on Wednesday that 811 provides “a lot of value” and “much of the report does support that.”

Delorey said the concerns expressed by doctors may be tied to the “original narrative” in which 811 was designed primarily to keep people out of emergency departments.

“[It would] be very easy if you’re on the frontline to say, ‘Well, the system can’t work if we’re seeing more patients here,'” he said.

Delorey said his department was discussing ways to better publicize the service and more accurately explain it to care providers so there’s a better understanding and appreciation of where it fits within the health-care system.

The report by Davis Pier was compiled using information gleaned from:

  • Telephone surveys with 414 people who have called 811.
  • Online surveys completed by 15 paramedics, 302 nurses and 48 physicians.
  • Interviews with eight managers and a focus group that included four family practice nurses and 15 doctors.

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