What is it about phone helplines that so appeals to politicians and health providers? . Hardly a week goes by without an announcement that the government – Federal or State – is putting millions into a new XXXX name-your-problem helpline. Drugs? Pregnancy? Call Centre Phobia? We have a helpine, just call 1300 …
It would be interesting to know how many of these phone services are now being funded with public money and what results they get. And are they evidence based and safe? Pharmaceuticals have to be reviewed by the TGA and then the PBAC for cost effectiveness before they get a subsidy, while medical procedures have to get the nod from the Medicare Services Advisory Committee. But when it comes to phone services, well, if it sounds like worthy cause and gets lots of calls then it surely must be A Good Thing. And most importantly the minister for this or that can be seen to Be Doing Something.
Interestingly, we haven’t heard much of Tony Abbott’s controversial pregnancy counselling service since the Coalition left government. This is the service that is costing is almost $4 million a year and according to the Australian is fielding just over 300 calls a month (link)
My back of an envelope calculations suggest that it’s costing $1000 a call. It would be cheaper to give pregnant women and their partners a free weekend at the Hilton to think about their options.
However, the 800 pound gorilla in the room of telephone services is HealthDirect. Already up and running in Western Australia, South Australia, the ACT and the Northern Territory, we are now about to get access to this nurse-based telephone triage service in NSW.
It costs literally hundreds of millions of dollars – jointly funded by the Commonwealth and States – but what does it actually deliver? I’m sure that worried parents feel reassured when they can call for help advice for an ailing child in the early hours, but is that the best way to spend scarce health dollars? Especially when Medicare is putting GPs’ after hours services under increasing scrutiny? The whole helpline service sounds like an expensive gimmick, and it’s time it was disconnected.
What do you think?
Comments
My daughter works at such a call centre and we feel she supports the community very well.This is what she had to say re your piece=that he has been a doctor too long- and has forgotten what it is like to be someone without ANY medical knowledge.... i think anything that helps people feel reassured isn't too bad a thing-- maybe he should be asking, why the people feel the need to call the helpline- that they are unable to get into the doctors, or want to check it is worth going to the doctors, and that most doctors (and indeed hospitals) use the service as an after-hours screening process. not perfect but i think it is handy...
Posted by Dr Esther Richard on Tuesday, 5 August 2008
This is a very good point. There is certainly a push from governements that health services can be delivered via helplines. When in fact there is definitate limitations to this service.
There has been a definite push from governments in the past decade to suddenly start a helpline for any new health or mental health condition. This is somewhat startling considering that helplines only provide a very small part of the entire service delivery to patients. Goverments seem to like these services because they produce an overwhelming amount of data, such as demographics, age, referral, diagnosis and so forth. This can be used to inform and assist service delivery in other areas.
The other push from goverments to helplines is that geographically this is a cost effective way of providing services to rural and remote areas that otherwise may not receive any services. As it can claim that it reaches population areas without any need to build facilaties and appoint specialised staff.
However what I am most concerned is the fact that helpline services are not regulated and there is an increasing overlap of services. There is no regulatory body that oversees helplines and any person or organisation can start a helpline without certification or accreditation.
Services such as Pregnancy helpline at least does provide clear professional standards and a level of support to callers that is regularly reviewed. This surely must benefit the caller.
However on the other side of the coin, Governments are overlooking services that are already in existence who are doing a great job at much less cost to the taxpayers than that of a new service.
The problem with governements starting these services is that they seem to be focused on the need to reach many with the most bang for the dollar. My concern as a clinician is that this approach often overlooks the ability to provide quality of services, which often requires continuity of care and the flexibility to know your patients. (this obviously cannot be met by helplines). If too much money is provided to this mode of service delivery surely other sectors will be disadvantaged.
Bill Campos Psychologist B.Sc M.Psych MAPsS President of Helplines Australia
Posted by Bill Campos on Wednesday, 30 July 2008
Well said. The industry in call centres has grown hugely and the real issues are that although seemingly popular with population and politicians alike, they achieve very little at great cost and allow the semblance of action where none really exists. They are often set up to "redirect patients away from Emergency". The evidence based literature including multiple randomised trials shows no effect in moving patients away from Emergency and in 2 trials suggested the opposite effect (http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004180/frame.html ). This was particulalrly true for nurse lead remote protocol driven services like Health Direct in Australia. Like most feel good services they have concentrated their "evaluations" on public perception, call answering times and numbers of calls taken "proving " that they are a valuable service. However in fairness there is no real evidence that they are unsafe ( the protocols are written with very low thresholds for referral on top a doctor- hence the lack of effect or promotion in ED attendances) or provide unsafe outcomes. They do also reduce the number of phone calls fielded by GPs after hours and Emergency departments. The real problem and danger of these services are that they divert funding ( each call costs about $25-45 depending on service), staff ( 30-100 fully trained nurses) and the attention and political will away from real remedies for our ailing health systems. As rightly pointed out by this article they are just too easy a way for politicians to look like they are doing something when in fact they are misdirecting resources to a poorly validated and cost ineffective service.
Dr David Mountain MB BS FACEM Emergency Physician WA
Posted by Dr David Mountain on Tuesday, 29 July 2008
