In Estonia, the Medical Consultation Centre provides a nation-wide family doctor advice line service to get patients more involved in their care and ease the burden on the health care system by reducing unnecessary medical visits and ambulance dispatches.
The idea of such a nationwide counselling service was proposed by the Estonian Health Insurance Fund. In 2003, the Estonian Health Insurance Fund conducted a needs assessment survey to measure the demand for this service and to study the attitude of medical staff and other stakeholders towards it. After the need-mapping stage was completed, a tender for the provision of the service was conducted in 2005 and it was awarded to the Medical Consultation Centre, or Arstlik Perenõuandla OÜ as it is known in Estonian.
“Currently, a major part of what we do is anonymous telephone consulting,” says Klarika Kallikorm, project manager of the national family doctor advice line 1220. “People who call the advice line on 1220 are not required to give their name or personal data to get health advice from our counselling staff.”
The advice line was established with a view to reducing the burden on the health care system by getting patients more actively involved in their care. “On the one hand, our goal is to get people to take more responsibility for their health and trust their gut feeling in deciding whether they really need to leave their home to get some health-related advice. On the other hand, the advice line is targeted at reducing the time that doctors spend face-to-face with their patients because the latter is the most costly type of healthcare services,” Kallikorm explains.
To date, the Medical Consultation Centre has operated the family doctor advice line for the Estonian market for almost 12 years. What is more, it readily shares with other countries expertise gained over the years. For example, assistance is currently provided to Kyrgyzstan, which is planning to merge its small-scale, regional call centres into one operated on the national level – just like in Estonia.
Counselling staff receive help from a medical algorithm
Kallikorm is pleased to announce that the advice line is quite popular among people and that the number of calls has constantly grown year over year. Last year, the number of statistically qualified calls made to the advice line was 240,464, while only a year earlier the figure was 233,649. “It is clear that the advice line provides a much-needed service,” Kallikorm comments.
According to her, the most frequent callers are parents of infants and the elderly. Statistical data indicates that last year people made the greatest number of calls to get medical advice about various diseases and their symptoms as well as medications. “Also, people often ask questions about administrative matters related to healthcare, for example, how to obtain a medical certificate or make a doctor’s appointment,” Kallikorm adds.
The advice line is staffed by family doctors and nurses as well as emergency physicians and nurses who all have received appropriate professional training.
To help counselling staff in their work, there is a medical decision support system in place. “A professional providing the service can enter symptoms described by a caller into an algorithm-based system which then displays a list of potential medical conditions,” Kallikorm explains. She adds that counselling staff refrain from making references to specific diseases because it is impossible – and strictly forbidden – to give a diagnosis to an anonymous caller over the phone. “However, we can encourage a caller to turn to a family doctor or a medical specialist to have the symptoms checked out,” says Kallikorm, adding that consultants also give advice on simple home remedies.
“There is a direct forwarding option available: when it is us that the patient calls first, our staff hear him/her out to get all the symptoms and if it becomes clear that the patient needs emergency medical care, we can forward the call straight to the emergency response centre.”
Focus on personalised counselling
The Medical Consultation Centre has now focused on personalised counselling of patients, which means that it is planned to interface the advice line with the Health Information System (TIS, or Digilugu). “Currently, we are working to obtain – besides offering anonymous consultations – the capacity to give personalised advice,“ Kallikorm says.
She explains that providing personalised counselling is vital for improving service quality. “At the moment, our staff give advice to anonymous callers. When there is an incoming call about medications, we are actually in the dark about the medications a patient is taking and it is often the case that patients don’t remember exactly what they have been prescribed. Others call us to get help in understanding lab test results that they have received from their family doctor or a medical specialist, but currently we cannot assist them because we don’t have access to their medical records,” Kallikorm explains the predicament.
“There is no doubt that personalised consultations is the best way to help a patient – our staff will be able to access previous entries about a patient, his/her reasons for visiting a family doctor or a medical specialist and information available through the prescriptions centre. As a result, advice given to a patient is not impersonal – not a case of groping around in the dark – but is soundly based on his/her medical history.”
Kallikorm notes that while the family doctor advice line is fully financed by the Estonian Health Insurance Fund, it is the company that has to find funds for its development. This includes the development phase for providing a personalised counselling service. “We work together with the Connected Health Cluster co-development team to design a universal TIS-interface model prototype, then present it to the state and if the state is interested in it, the prototype can be taken into wider use,” she elaborates on the process.
In addition, Kallikorm speaks highly of the Connected Health Cluster: “We have received a lot of support and information as well as a variety of exciting development ideas from the Cluster.” She adds that the cluster definitely offers far more opportunities than the company is able to make use of.