Telephone triage in urgent unscheduled primary care in 16 European countries: a cross-national questionnaire-based expert study

Rising demand and workforce shortages challenge European healthcare systems. Unscheduled healthcare, including out-of-hours (OOH) primary care, is often managed through telephone triage. Improving triage quality is essential to maintain accessible and sustainable unscheduled care across Europe. To describe the role and organization of telephone triage in OOH primary care services that provide care for patients with urgent unscheduled health problems. A cross-national questionnaire-based expert study. We developed a web-based questionnaire that was distributed to members of a European research network on OOH primary care (EurOOHnet), aiming to have one informant per country. Questionnaire data were validated through email consultation with informants. Expert informants from 16 countries completed the survey. Most countries had general practice care, ambulance care, and emergency departments to provide urgent unscheduled care. Access routes to unscheduled care varied considerably between countries; 11 countries used telephone triage. Three triage models were identified: 1) Triage to care, 2) Advice and referral, and 3) Advice helplines. Self-advice tools, triage preparation tools, and chatbots were uncommon. We identified three triage models that had different roles related to access to unscheduled care. Telephone triage is used frequently to fit demand to available resources.