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Parents prefer an on-call pediatrician to a nurse advice service to discuss their child's medical problems

In the past, when parents had urgent questions about their child's health after office hours or on the weekend, they called their pediatrician. In recent years, professional telephone triage systems, often manned by nurses, have grown rapidly to meet this need, with an estimated 100 million people using such services. However, parents say they are less satisfied with the medical advice provided by a nurse advice service compared with the traditional on-call pediatrician, according to a study supported by the Agency for Healthcare Research and Quality (HS10604).

The researchers randomized after-hours medical advice calls from parents or guardians of about 6,000 children seen over a 10-month period in 2000 at the pediatrics practice of an urban university medical center to either a nurse advice service (566 callers) or the on-call pediatrician (616 callers). They surveyed callers within 3 days after their initial advice call about their satisfaction with the telephone triage service and subsequent health care use. Although the callers who spoke to nurses were given almost identical advice, spent less time waiting to have their calls answered, and spent more time speaking on the phone than callers who spoke to the on-call pediatrician, they were much less satisfied, less likely to comply with the advice, and more likely to call back within a short time for more advice.

Parents rated call satisfaction as very good or excellent significantly more often for the on-call pediatrician than for the nurse advice service. Adults who spoke to the on-call pediatrician were more likely to comply with advice given for an office visit within 72 hours than those who spoke to the advice nurse (52 vs. 30 percent) and less frequently made repeat calls for advice both within 4 hours (5 vs. 13 percent) and within 72 hours (13 vs. 23 percent). The researchers suggest that future studies examine whether the potential cost savings of nurse telephone triage services is worth the possible decline in patient satisfaction.

See "Caller satisfaction with after-hours telephone advice: Nurse advice service versus on-call pediatricians," by Thomas J. Lee, M.H.S., M.D., Judith Guzy, B.S.N., David Johnson, Ph.D., and others, in the November 2002 Pediatrics 110(5), pp. 865-872.

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