It isn’t always easy trying to decide what to do about a sudden pain in the middle of the night. Should you go to the emergency room? Or should you wait and call your doctor in the morning?

For subscribers to the FirstCarolinaCare insurance plan, there is always someone to turn to, whatever time of day a health question arises. A 24-hour Nurse Helpline has been a feature of FirstCarolinaCare coverage since 2002.

“The purpose of this program is to give our members access, 24 hours a day, to a nurse,” says Sandra Morris, director of Health Services. “Members can ask questions if they have concerns about a particular issue or get advice in terms of what they need to do for care.”

The helpline is staffed by registered nurses who give advice based upon specific criteria developed by nationally acknowledged experts in various fields.

While the nurses obviously cannot practice medicine, they can dispense useful information with regard to preventive care, medications and specific health conditions.

And for those new mothers who wake up in the middle of the night to a crying baby with a fever? “The nurse can really help when it comes to the ‘fright factor,’” says Morris, herself a registered nurse with more than 20 years of experience in managed care. “The nurse can help a worried parent clarify a decision on whether or not a visit to the emergency room is warranted, or in what situation a call to the doctor can wait until morning.”

In addition to one-on-one interaction with a registered nurse, the helpline also offers an audio library. “For instance, if you’ve gone to a physician and you find out you’ve got high blood pressure,” says Morris, “and you get home and think of questions that you didn’t ask your doctor, you can call the helpline and be patched through to an audio library where you can listen to a tape about your diagnosis.”

Caring for people
The Nurse Helpline serves as an important part of FirstCarolinaCare’s commitment to offer educational resources to its members. “It’s another tool for our members,” Morris says, “to help them become educated, help them make some choices and to help them become better health care consumers.”

When new companies sign up with the insurance plan, members receive refrigerator magnets with the Nurse Helpline number on them.

“I think that, for some people, it’s not that they’re intimidated by their physician but they think, ‘Gosh, my doc’s so busy, I don’t want to take up his time,’” says Morris. “So they can go home with questions that, unfortunately, might have been helpful to them had they gotten them answered.”

That’s when being able to talk to a nurse—on your own timetable—can come in handy. A helpline nurse can reassure members with general information, and then help them hone in on questions that they might want to write down and take with them to their next appointment.

Morris points out that FirstCarolinaCare, as a wholly owned subsidiary of FirstHealth of the Carolinas, shares the same mission: to care for people.

“FirstHealth is looking at all aspects of health care,” Morris says.That emphasis carries through at FirstCarolinaCare.

“As an insurance company, FirstCarolinaCare is unique in that we have so much personal touch with our members,” says Morris. “FirstCarolinaCare also has nurses who go out to health fairs and offer chronic condition management. When we discover someone with diabetes, or other chronic conditions, a nurse actually goes out to meet with them, helps educate them, and helps get them in the right programs.”

The Nurse Helpline is intended as both a resource tool and a way for members to access information after hours. A middle-of-the-night or weekend call may save a member a trip to the ER, as well as the expense of the visit.

“As we all know, ER utilization is extremely high and it can be costly,” Morris says. “So this can be a less costly alternative.”

The helpline nurse may also motivate a member who doesn’t realize the importance of his or her symptoms to seek immediate attention.
For those who might be reluctant to make an appointment, hearing a nurse say that it’s necessary can make the difference between procrastination and proactive health care.

“The nurse will ask questions based upon the protocol,” Morris says. “And if there’s any uncertainty, we tend to take the conservative route and advise the caller to see their doctor.”

According to Morris, use of the helpline is completely confidential. “It is in no way tied to benefits,” she says. “If you don’t use the call line and you go to the emergency room, you’re not going to be penalized because you didn’t call first.”

FirstCarolinaCare’s Nurse Helpline is not meant to replace any services offered by a member’s health care provider, including after-hours telephone assistance or referrals to a specialist.

“Our members are informed when the helpline is answered that if they are in a health crisis, they need to go to the nearest emergency department,” says Morris.

Who calls?
The majority of the calls that the helpline receives are, as one would expect, related to home care and self care. The top three health areas that helpline nurses get asked about are gastrointestinal problems, pediatric colds and earaches, and minor accidents—all good reasons to call a nurse for advice.

While the helpline has offered information and reassurance to many FirstCarolinaCare members, Morris wishes more would take advantage of it.

“I would say to our FirstCarolinaCare members, please use it,” she says. “There’s no charge, it’s absolutely confidential, and it is a very good resource.”

FirstCarolinaCare subscribers can access the Nurse Helpline at (800) 336-2121.