Supporting Self-Care: The Contribution of Nurses and Physicians

APPENDIX B
Selected Programs and Tools

Description

The Info-Santé CLSC (Centres Locaux de Services Communautaires; Local Community Services Centres) Line is a nursing telephone information and advice service that responds to health and well-being concerns of the Quebec population. This service is offered 24 hours a day, 7 days a week. In most cases, the caller simply calls his or her CLSC. During the day, each CLSC responds to local calls. Outside business hours (i.e., evenings, nights, weekends and holidays), calls are automatically transferred to one CLSC, which plays the role of regional telephone centre. Info-Santé CLSC has three main functions: greeting/assessment, information/advice, and referrals (Dunnigan 1995).

Dr. Yves Langlois, a general practitioner from a Montreal suburb, finds the referral and advice functions of the Info-Santé CLSC particularly useful. "I was quite sceptical at the beginning, but I am no longer. Info-Santé CLSC refers people to the right places and provides useful advice. It facilitates self-care and eliminates unnecessary consultations."

The first line started in Quebec City in 1984 as a telephone centre operating 24 hours a day, 7 days a week. In 1989, the Outaouais region started a similar service operated by nine CLSCs during business hours and by a regional telephone centre during other times. Between 1988 and 1992, several different types of Health Line services were initiated in other regions of Quebec. These various experiences, along with the findings of associated preliminary evaluations led the provincial Department of Health and Social Services to recommend the extension of these health lines to the whole province with the exception of 2 of the 18 health and social regions, which are Cree and Inuit territories. A reference framework published in 1994 defined the objectives, main functions and guiding principles of the service and identified its success factors. It recommended a decentralized model in which all CLSCs (at the time of writing, there are 159) of a region respond to requests on week days (Dunnigan 1995).

In 1994-95, 58% of the Quebec population had access to Info-Santé health line services. Two years later, in 1996-97, it is expected that 99.5% of 7,400,000 Quebecers have access to this service. It is estimated that 850,000 telephone calls were responded to in 1994-95, and that this number will more than double in 1996-97. Clearly, it is a rapidly expanding service. Three main tools, which will soon be computerized for the nurse operators, have been developed for the Info-Santé CLSC Line:

• The Nursing Protocols Inventory, published for the first time in 1995 as a result of four years of extensive efforts by a team of nurses, facilitates the diffusion of standardized and scientific nursing advice by the Info-Santé CLSC line. The protocols have been organized according to the 14 needs identified by Virginia Henderson, an American pioneer in nursing and in research related to patient autonomy. The protocols are available in French and in English.
• The health and well-being Resource Directory is a description of the various services and organizations (public, private and community-based) located in the different CLSC territories, with additional information on regional and provincial services. Plans have been made to update this tool regularly.
• The Call Record Sheet will allow the provision of statistical data to assess various aspects of the service: reasons for calling (nature of the problem), type of advice or referral provided, evaluation of user's satisfaction, call duration, etc.

A number of studies have documented several descriptors of the Info-Santé CLSC service, such as types of clients, utilization frequency, reasons for calling, service provided and call duration. However, few results of evaluations concerning outcomes or impact of interventions are yet available. An important impact study concerning users' autonomy and satisfaction was initiated in 1995 by the Info-Santé CLSC of Quebec City. The results of this evaluation indicate that Info-Santé CLSC is effective in developing the self-care capacities of users and creates substantial savings in health care costs (Hagan and Garon 1996). Initial results from a province-wide evaluation should be available in 1997.

Characteristics of Note

Client-centred

The Info-Santé CLSC Service is a personalized service that focuses on the needs and ability of each individual caller.

A young mother consulted Info-Santé CLSC in the Eastern Townships about her three-week-old baby. "I heard about Info-Santé during a postnatal visit from the CLSC following my delivery and two-day stay in the hospital. I phoned with a few questions concerning breast feeding." In response to her questions, the nurse provided both information and advice. The nurse informed her that she could obtain additional information from La Leche League and referred her to certain parts of From Tiny Tot to Toddler, a book provided to all new mothers in Quebec. "The nurse was very nice. I am satisfied with her answers to my questions, I feel reassured," stated the mother.

Learning and personal development

People often call The Info-Santé CLSC Service for a personal health problem or for a health problem of a family member (such as a young child). During the first part of the interaction, the nurse greets the person and asks a number of questions to assess the situation. This process often stimulates an improved awareness on the part of the caller by clarifying the nature of the problem and related concerns or worries. In certain cases, the person is referred to a physician or to the nearest hospital. But often the nurse provides advice to the caller about how he or she can deal with or monitor the presenting health problem. In such cases, it is often an opportunity for the caller to increase his or her confidence and to learn or practise skills in self-care.

For Further Information

• Contact any CLSC in Quebec or the Fédération des CLSC, tel. 1-800-361-4661.

References

Dunnigan, L. 1995. Service téléphonique accessibilité continue 24/7: étude préliminaire et propositions en vue de l'évaluation des résultats et de l'impact du service. Québec: Ministère de la santé et des services sociaux.

Hagan, L. and Garon, G. 1996. Info-Santé CLSC, région de Québec: Un service infirmier efficace? Québec: Centre de recherche sur les services communautaires.