Money spent on 811 not the best 'bang for your buck,' Nova Scotia doctor says

Advocates for Nova Scotia's 811 medical advice line say it can prevent unnecessary emergency room visits and give peace of mind. But one family doctor says the $5 million for the service would be better spent elsewhere.

Medical advice phone service that started in 2009 currently under review by province

The 811 phone line employs 52 full-time employees at a cost of $5.2 million in 2016/2017. That breaks down to almost $51 per patient per call. (Natasha Halili-Banks/Nova Scotia Department of Health and Wellness)

Spending more than $5 million a year on Nova Scotia's 811 medical advice line isn't the "best bang for your buck," according to a family physician who says the money would be better spent on after-hours care done by doctors.

Dr. Barb O'Neil, a family physician based in Kennetcook and chair of a primary care council with Doctors Nova Scotia, said the 811 service — first launched in July 2009 in the midst of the H1N1 flu epidemic — is not the most "cost-effective way to deliver care."

"It's actually more money per call than what a family physician is paid to see a patient in person," said O'Neil, a doctor who does after-hours care. "So, it's hard to really justify that."

The 811 service, currently under review by an independent consulting firm hired by the province, connects Nova Scotians by phone with registered nurses who can assess their symptoms and suggest next steps.

Advocates of the service say it can divert people away from needless emergency room visits, and can also give family members peace of mind when they are concerned about a health issue with a child or other loved one.

Department of health spokesperson Tracy Barron said the review is underway to ensure the 811 service is "delivering results as intended." She said a preliminary report is expected this spring.

Numbers provided by the Department of Health show that 101,540 patients used the service in 2016/17 at a cost of $5.2 million. 

That's approximately $51 per patient, compared to the $32 that Doctors Nova Scotia says the province pays family physicians to see a patient in person.

The 811 budget covers 52 full-time employees including 28 registered nurses, front-line staff who triage callers when the nurses are on other calls, IT staff, and administrators. The service is available in 125 languages.

Advocates of 811 say it can prevent patients from making unnecessary emergency room visits. (Andrew Vaughan/The Canadian Press)

The 811 budget would be better spent, O'Neil said, if it were put toward paying family doctors — and the nurse practioners and nurses working with them in collaborative family practices — to be on-call and accept after-hours calls.

O'Neil said she is one of about 30 family doctors in the province who is still paid to do after-hours care — at a cost to the province of approximately $25,000 a year per physician.

But that pool of money dries up at the end of March when a stipulation in the new doctors contract kicks in. 

O'Neil said it simply makes more sense for people who know the patient — and can access their medical records — to take after-hours calls and give medical advice.

The 811 nurses can't do physical examinations or check on the patient's medical history, she said, so they often have to play it safe and advise patients to seek additional care.

As a result, the 811 service sometimes causes unnecessary panic and an exaggerated "sense of urgency," O'Neil said, causing patients to rush to their doctor, walk-in clinic or emergency room for treatment when it isn't really warranted. 

This, in turn, creates extra work for medical staff, she said, and clogs up the system.

Dr. Barb O'Neil says the money spent on 811 should be put towards more doctors taking after-hours calls. (Barb O'Neil)

But Dawn MacMillan, a registered nurse who has been advising patients through 811 for about two and a half years, said the phone service frequently prevents people from making unnecessary visits to the emergency room. Often, she said, she'll advise people to follow basic care instructions at home.

It's an "awesome" service, MacMillan said. The people who call are "very appreciative," she said, adding callers often say they don't know "what they would have done if they hadn't called us."

MacMillan said she feels she makes the biggest difference when talking to parents about their children in the middle of the night. She said she can "almost hear that sigh of relief" at the end of each call.

Helen Earley, a Halifax freelance writer, said it was comforting to know she could call 811 when her kids — currently four and nine — were sick.

As a new parent "every chill or fever kind of freaks you out," she said, and "811 can kind of talk you off the ledge."

Earley said the last time she called the hotline had nothing to do with parenting. It happened after her husband slipped and fell down the stairs, snapping a rib.

In that case, she said, the 811 nurse advised her to call for an ambulance. But overall, Earley said calling 811 has probably saved her a few visits to the emergency room.

The last time Helen Earley called 811 was when her husband, Mike Barker, fell down the stairs and snapped a rib. (Helen Earley)

Regarding her concerns about the effectiveness of 811, O'Neil said leaning on physicians to provide after-hours care would be a challenge right now, due to the doctor shortage in the province.

"I don't think you can necessarily eliminate 811 before we have something to replace it," she said, but "we could tweak it a little bit" in the interim.

O'Neil said she wants to see more communication between 811 nurses and doctors, so that physicians know what happened during an overnight call to 811 before they see their patients again.

It would also be helpful to know how many of her patients have called 811 in a given month, she said, and what they were calling about. This would help her zero in on where the gaps are in care, O'Neil said, so she can make adjustments.

About the Author

Nina Corfu

Associate Producer

Nina Corfu is a journalist based in Halifax. She aims to tell stories that people want to share around the dinner table each night. If you have a snackable story idea to share, please drop her a line at nina.corfu@cbc.ca.

With files from the CBC's Information Morning

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