Awareness of the Patient Service Telephone Number 116117 and Willingness to Use a Symptom Checker

The most recent draft legislation to reform emergency care in Germany provides for patients to be assessed first by an Emergency Operations Center with telephone and digital support and then directed to an appropriate care service before attending the emergency room. So the aim of the present study was to determine the level of awareness of the patient service telephone number provided by the German Associations of Statutory Health Insurance Physicians (KV; “116117”) and the willingness of patients to independently use a digital tool (symptom checker) to determine the urgency of their need for treatment and accept any subsequent treatment offer in a doctor’s practice.

Methodological approach

Data acquisition

As part of a comprehensive and anonymized questionnaire survey of patients in five emergency rooms in Berlin, the level of awareness of 116117 and willingness to use a symptom checker were also assessed. From March 18 to April 18, 2024, from Monday to Sunday, trained student assistants using tablets undertook the survey in waiting rooms and treatment areas after obtaining informed consent. The questions were answered either independently or with support from the assistants. The study received a positive opinion from the ethics committee of the Charité – Berlin University of Medicine (EA2/037/24) and was registered in the German Clinical Trials Register (DRKS00033986).

Study population

Self-referring patients and those arriving by ambulance were included in the study, regardless of age. Patients with an immediate need for treatment (following triage), those without satisfactory knowledge of the German language, and those who were unable to provide informed consent were excluded. Reasons for refusing to participate were also asked.

Evaluation

Descriptive statistics were initially used to analyze secondary endpoints. Multivariate logistic regressions were conducted to determine influencing factors of 116117 awareness and willingness to use the symptom checker. Statistical analysis was carried out using IBM SPSS Statistics 20.

Results

Study population

During the study period, n = 13 701 patients attended the participating emergency rooms, n = 4347 were approached and invited to participate, and n = 2512 gave their consent. A total of n = 708 were excluded, and n= 1127 declined participation. Around half of those interviewed (49.3%) were female (n = 1204), 22.9% were 29 years old or younger (n = 560), 41.7% were aged 30 to 59 (n = 1019), and 35.4% were 60 or older (n = 867). A migration background (1st/2nd generation) was reported by 29.7% (n = 709) of the participants.

Awareness of number 116117

The number 116117 was known to 68.8% (n = 2378) of the respondents. The likelihood of being familiar with 116117 was increased in the under 18 years age group (odds ratio [OR]: 2.1) and in patients with a higher education level (OR: 2.3). A migration background lowered the likelihood of being aware of the telephone number (OR: 0.3) (Table 1). Patients with a higher education and a first-generation migration background (n = 179) were aware of the number 116117 more commonly than less educated patients with direct experience of migration.

Table 1

Multivariate logistic regression on the awareness of 116117

Willingness for digital self-triage

A total of 36.3% (n =2441) of the respondents were open to digital self-triage of their symptoms, and 89.3% (n =1025) were prepared to follow subsequent advice if treatment in a doctor’s practice were recommended and an appointment offered. The likelihood of being willing to use a symptom checker was lower in the age groups of 40 to 59 years and 60 years and older (Table 2).

Table 2

Multivariate logistic regression on the willingness for digital self-triage

Discussion

Awareness of number 116117

Around 69% of the study participants stated that they were aware of the number 116117—around 15 to 20% more than in other studies (1, 2). Our results suggest that the chance of reaching certain groups using current public relations efforts is low, such as those with a lower level of education or a migration background. The draft legislation to reform emergency care, however, relies on prior contact with the Emergency Operations Center. Consequently, targeted awareness campaigns would need to be conducted to reach these groups in order to provide them with detailed information before attending the emergency room. Furthermore, our study also suggests that poor use of 116117 may well be due to the lack of understanding of the various care services available. Awareness of the available care services, however, is an essential precondition if redirection is to succeed.

Self-triage in the emergency room

The most recent draft legislation to reform emergency care as discussed in the German Bundestag provides for integrated emergency centers (emergency rooms affiliated to a KV emergency practice) as the primary port of call for patients with an acute need of care in emergency rooms. Redirection by cooperating practices is planned during regular office opening hours, although the amount of time required for this under everyday working conditions and the issue of “patient safety” remain unclear. Additional triaging by the patients themselves at home or in the hospital could be a possible approach. Just under one third of respondents in the present study was open to the use of a symptom checker, with a large part of these also being in favor of alternative care services outside the emergency room. Initial studies on the use of symptom checkers in emergency rooms have yielded heterogeneous results. Whereas some studies indicate shorter waiting times, a more rapid identification of outpatient cases, and a safer use without overtriaging (3, 4), others have revealed overtriaging and low accordance with established triage tools (5). Thus, successful redirection also presupposes a centralized telephone or digital service. Further studies will need to look at whether the workload of all staff at the reception desk is reduced, the impact on time schedules in the emergency room, and the safety of use for patients.

Limitations

It is possible that attitudes of individuals without adequate knowledge of German may not have been fully reflected. The number of refusals to cooperate could have resulted in a distortion of the results.

Funding

The Central Research Institute of Ambulatory Health Care in Germany financed the conduct of the study.

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Acknowledgments

We would like to thank Dr. Mandy Schulz and Dr. Dominik von Stillfried at the Central Research Institute of Ambulatory Health Care in Germany for their support and all the teams at the participating emergency rooms, especially Stefanie Kroll (Helios Hospital Berlin-Buch), Denise Lee (Charité—Berlin University of Medicine), Dr. Philipp Klupp (Vivantes Hospital Berlin-Friedrichshain), Dr. Sebastian Karmann (Vivantes Network for Health), Dr. Ulrike von Arnim, Yvonne Rosipka (Vivantes Hospital Neukölln), and Stefan Wollschläger (Unfallkrankenhaus Berlin).

Sarah Oslislo*¹, Kalina Witt*¹, Philipp Kellner, Hajo Schmidt-Traub, Christian Wrede*², Rajan Somasundaram*²

*¹These first authors contributed equally to this article.

*²These authors share last authorship.

Central Research Institute of Ambulatory Health Care in Germany (Oslislo, Witt), [e-mail]; Vivantes—Network for Health in Berlin, Medical Services Berlin-Friedrichshain (Kellner); Medical Services BG Unfallkrankenhaus Berlin (Schmidt-Traub); Emergency Center Helios Hospital Berlin-Buch (Wrede); Medical School Berlin (Wrede); Charité—Berlin University of Medicine, Central Emergency Department at Charité Campus Benjamin Franklin (Somasundaram)

Conflict of interest statement
SO and KW are employed at the Central Institute for Statutory Health Insurance in the Federal Republic of Germany, the provider of Structured Medical Assessment in Germany (SmED).

The authors declare that they have no conflicts of interest.

Manuscript received on 15 November 2024, revised version accepted on 1 April 2025.

Translated from the original German by Dr. Grahame Larkin.

Cite this as:
Oslislo S, Witt K, Kellner P, Schmidt-Traub H, Wrede C, Somasundaram R: Awareness of the patient service telephone number 116117 and willingness to use a symptom checker. Dtsch Arztebl Int 2025; 122: 306–7. DOI: 10.3238/arztebl.m2025.0065

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