Why to develop such a service?

The role and position of similar service in Estonian health care system (1)

• The Estonian health care system is based on mandatory solidarity-based health insurance system where private service providers ensure access and availability of services necessary

• 1991: reform for launching general practioner’ centered health care system was started

• 2002: the reform was completed by enacting the Health Care Organisation Act stating that the entry point to general health care system is the general practitioner (family doctor).

The role and position of similar service in Estonian health care system (1)

• 2003: a survey was conducted to analyse the need for phone-based primary health care counselling service. 69% of the respondents (aged 15-74) agreed that the possivility to consult a general practitioner 24/7 is important and 89% of the respondents said that they would use such a service, if it existed.

• 01.08.2005: launching the Family Doctor Advice Line 1220– 138 868 calls in 2006– 270 000 calls in 2014 (prognosis) – i.e. every 6th Estonian inhabitant

uses the service• The service has considerably improved access to general health

care outside usual working hours and for the inhabitanats in remote and rural areas. The service has become an integral part of the Estonian health care system and it is available to everyone, notwithstanding their location, socioeconomic status or availability of medical insurance.

Why?• Ageing population – increase of demand for

medical consultation and services

• Expectation of population with regard to accessibility of medical services

• Quick development of technologies of medical sciences – new possibilities

The service• counselling on medical problems and health

care system-related issues via telephone 24/7

in main languages of the country

accessible in abroad

When?

• Unexpected health problems, especially in the evening, night or in the weekend – doctor may not be accessible

• Minor health problem, when it is not necessary to use the emergency aid service

• Medical consultations of primary health care level to persons without medical insurance

What kind of questions?

• Critical health-related problems, which will be transferred to emergency aid

• Primary health care problems

• Psychological advice and crisis aid

• Health care management issues

How?

• Doctors and nurses answer to the questions, using medical algorithms based ICT solution

• Ensures high quality of consultation and similar answers to similar questions

Statistics

• Average number of calls per month - 22 500, per year - 270 000– Average length of call – 3 minutes– Estonian population – ca 1 300 000, up to

20% use the service annually– High satisfaction with the service among

clients and financers

Main problems

• Temperature among children

• High blood pressure among adults

• Seasonal diseases− viruses− allergies− heat strokes− traumas− indigestions

Organisation

• Service accessible 24/7 • 17 counsellors (both family doctors and nurses)

with full workload needed per month• 90% calls will end with guidelines of home

treatment, i.e. no need to create additional workload for health care system– less than 0,5% of calls are directed to Emergency

Service 112– 10% of callers are advised to make appointment at

doctor or visit the emergency aid department

Estonian experience abroad

• Moldova - http://www.youtube.com/watch?v=zikYs7k_yxI

• Russia– Pskov region– St. Petersburg (Kolpino)

• Macedonia

Possible integration with other e-solutions

• Electronic health record: possibility to provide personalised counselling via enabling secure access to the anamnesis of the caller

• E-registration: possibility to arrange appointment with specialist doctor during the counselling

• E-prescription, E-sickness leave documentation etc

Benefit

• Improved access to medical consultation and information – increases the sense of security among population

• Decreases work-load among (especially family) doctors, emergency aid and other services

• Ensures readiness for crises and epidemic situations

• Accessible to all people• Cost-effective