What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review

Objective The purpose of the evidence synthesis is to assess the nature and quality of the existing evidence base on delivery of emergency and urgent care services and identify gaps that require further primary research or evidence synthesis. Methods We have conducted a rapid framework-based evidence synthesis approach. Five separate reviews were conducted linked to themes in the NHS England review. A general and five theme specific database searches were conducted for the years 1995-2014. Relevant systematic reviews and additional primary research papers were included with narrative assessment of evidence quality was conducted for each review. Results The review was completed in six months. In total 45 systematic reviews and 102 primary research studies have been included across all 5 reviews. The key findings for each reviews were 1) Demand - there is little empirical evidence to explain increases in demand for urgent care, 2) Telephone triage - Overall, these services provide , appropriate and safe decision making with high patient satisfaction but required clinical skill mix and effectiveness in a system is unclear , 3) extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital. 4)ED – The evidence on co-location of GP services with ED indicates there is potential to improve care. The attempt to summarise the evidence about wider ED operations proved to be too complex and further focused reviews are needed. 5) There is no empirical evidence to support the design and development of urgent care networks. Limitations Although there is a large body of evidence on relevant interventions much of it is weak with only very small numbers of randomised controlled trials identified. Evidence is dominated by single site studies many of which were uncontrolled. Conclusions The evidence gaps of most relevance to the delivery of services are 1) more detailed understanding and mapping of the characteristics of demand to inform service planning, 2) assessment of the current state of urgent care network development and evaluation of effectiveness of different models, and 3) Expanding the current evidence base on existing interventions that are viewed as central to delivery of the NHS England plan by assessing the implications of increasing interventions at scale and measuring costs and system impact. It would be prudent to develop a national picture of existing pilot projects or interventions in development to support decisions about research commissioning

Delivery suite assessment unit: auditing innovation in maternity triage

yesA Delivery Suite Assessment Unit (DSAU) has been established at a large Northern teaching hospital. This was as a recommendation of ASQUAM (achieving sustainable quality in maternity) to reduce antenatal admissions to delivery suite and provide a more appropriate environment for women attending for antenatal or labour assessment. The DSAU has also provided an effective teaching environment where skills such as effective telephone triage, diagnosis of labour and care of women with pre-labour spontaneous rupture of membranes (SROM) have been developed by junior staff. The first twelve months' audit results indicate that the establishment of the DSAU has been successful in reducing antenatal admissions to delivery suite by increasing the transfers of clients home, rather than to the antenatal wards. This may reflect the confidence of the highly skilled midwives working in this environment and the confidence women feel about their ability to obtain prompt and accurate advice over the telephone

Predictors of Patient Satisfaction and the Perceived Quality of Healthcare in an Emergency Department in Portugal

The predictors of patient satisfaction in emergency medicine (EM) have been widely studied and discussed in the scientific literature; the results vary depending on the specific EM attributes, cultural aspects, researchers' preferences, and approaches. However, it is not clear whether the same predictors of patient satisfaction can contribute to a better-perceived quality of healthcare or whether patients' perceptions form a different attitude toward satisfaction and perceived quality of healthcare. The goal of this study was to identify the key predictors of patient satisfaction and perceived quality of healthcare in the framework of an emergency department (ED).info:eu-repo/semantics/publishedVersio

Exploring the role of nurses in after-hours telephone services in regional areas; A scoping review

Introduction The management of patients who need chronic and complex care is a focus of attention internationally, brought about by an increase in chronic conditions, requiring significantly more care over longer periods of time. The increase in chronic conditions has placed pressure on health services, financially and physically, bringing about changes in the way care is delivered, with hospital avoidance and home-based care encouraged. In this environment, nurses play an important role in co-ordinating care across services. This review formed one part of a funded project that explored the nurse navigator role within a proposed 24-hour telephone-call service in one regional area that has a diverse population in terms of cultural identity and geographical location in relation to service access. Aim The review reports on the extant literature on the nurse’s role in the provision of afterhours telephone services for patients with chronic and complex conditions. The specific aim was to explore the effectiveness of services for patients in geographically isolated locations. Methods The methodological approach to the review followed the Preferred Reporting System for Meta-Analyses (PRISMA) guidelines. A thematic analysis was used to identify themes with chronic care models underpinning analysis. Results Three themes were identified; nurse-led decision making; consumer profile; and program outcomes. Each theme was divided into two sub-themes. The two sub-themes for decision making were: the experience of the staff who provided the service and the tool or protocol used. The two sub-themes for consumers profile were; the geographic/demographic identity of the consumers, and consumer satisfaction. The final theme of outcomes describes how the effectiveness of the service is measured, broken into two sub-themes: the economic/workforce outcomes and the consumer outcomes. Discussion The provision of an after-hours telephone service, in whatever model used should align with a Chronic Care Model. In this way, after-hours telephone services provided by experienced nurses, supported by ongoing professional development and relevant protocols, form part of the ongoing improvement for chronic and complex care management as a health priority

Using the Andersen Behavioral Model of Health Services Use to Examine Adult Uninsured Patient Health Services Use at a Community Health Center

Prescription medications are essential to the treatment and management of chronic conditions (Smith et al., 2005). Lack of access can result in pain, worsening of the condition and increased risk of additional health problems. Health care expenditures in the United States were reportedly 1.7 trillion in 2003 (Smithetal.,2005) and exceeded role= presentation style= box-sizing: border-box; display: inline-table; line-height: 0; font-size: 16.66px; overflow-wrap: normal; word-spacing: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; max-height: none; min-width: 0px; min-height: 0px; border: 0px; margin: 0px; padding: 1px 0px; position: relative; \u3e1.7trillionin2003(Smithetal.,2005)andexceeded1.7trillionin2003(Smithetal.,2005)andexceeded2.3 trillion in 2008 (Centers for Medicare and Medicaid Services, 2010). Prescription medication costs constitute a significant burden for patients who are uninsured and managing chronic conditions and links to the likelihood of medication non-compliance (Piette, et al., 2006; Reed, 2005; Solomon, 2005). To enhance its chronic disease management model for uninsured patients diagnosed with chronic conditions requiring prescription regimens, a local community health center added a pharmaceutical access component to its health care delivery model. The purpose of this research was to test the ability of the Andersen Behavioral Model of Health Services Use to model health services use among adult uninsured patients managing physician-diagnosed chronic conditions. Andersen\u27s original Behavioral Model of Health Services Use, developed in the 1960s, suggests individual health behavior patterns are based on predisposition to care, factors that impede or enable the use of care and overall need for care (Andersen, 1968). This research documents particularly the independent contribution of increased access to prescription medication as an enabling resource. This study employed a longitudinal, quasi-experimental design covering a period of 90 days. There existed no random assignment or random selection. This project yielded 100% follow-up (N=427). Of the 427 participants, 61.6% (n=263) participants qualified for the stop-gap medication program offered by the host community health center. Participants who were not eligible for stop-gap medications were more likely to have a telephone encounter, physician/nurse triage visit and an emergency department visit during the follow-up period than participants who were eligible for stop-gap medications. For all four clinical outcomes, the mean follow-up readings were lower than the mean baseline readings for participants who had access to stop-gap medications. The largest predictor of a positive change in outcomes was access to stop-gap prescription medications when controlling for population characteristics and health behaviors

Telephone Referral to a Paediatric Emergency Department: Why Do Parents Not Show Up?

Medical call centres can evaluate and refer patients to an emergency department (ED), a physician or provide guidance for self-care. Our aim was (1) to determine parental adherence to an ED orientation after being referred by the nurses of a call centre, (2) to observe how adherence varies according to children’s characteristics and (3) to assess parents’ reasons for non-adherence. This was a prospective cohort study set in the Lausanne agglomeration, Switzerland. From 1 February to 5 March 2022, paediatric calls (<16 years old) with an ED orientation were selected. Life-threatening emergencies were excluded. Parental adherence was then verified in the ED. All parents were contacted by telephone to respond to a questionnaire regarding their call. Parental adherence to the ED orientation was 75%. Adherence decreased significantly with increasing distance between the place the call originated and the ED. The child’s age, sex and health complaints within calls had no effect on adherence. The three major reasons for non-adherence to telephone referral were: improvement in the child’s condition (50.7%), parents’ decision to go elsewhere (18.3%) and an appointment with a paediatrician (15.5%). Our results offer new perspectives to optimise the telephone assessment of paediatric patients and decrease barriers to adherence

Australia’s Alcohol and Other Drug Telephone Information, Referral, and Counselling Services: A Guide to Quality Service Provision.

Ann Roche, Keith Evans, Tania Steenson, Ken Pidd, Nicole Lee, Lynette Cusack

Developing a Vermont Nurse Triage Line: A Systems Improvement Project

Nurse Triage Lines (NTL) have been utilized since the 1970s as a healthcare service delivery model. The efficacy of their utilization has been proven in non-acute, mainly primary care settings. During the 2009 H1N1 pandemic in the United States, NTLs proved their efficacy in an acute emergency event. The Minnesota FluLine, the exemplar case study, showed a significant reduction in unnecessary healthcare resource utilization as well as a significant economic cost savings. This project performed an organizational assessment for the Vermont Department of Health (VDH) focused on implementing an NTL. Through qualitative semi-structured interviews with key informants, key themes surround the implementation of an NTL were identified utilizing a modified Strengths, Weaknesses, Opportunities, and Threats model. Through quantitative use of economic modeling, a cost savings analysis was preformed to explore potential cost savings for Vermont if an NTL had been established during the 2009 H1N1 Pandemic. Results of this project suggest that there is a need for an NTL. Furthermore, VDH is capable of implementing an NTL. Future projects should focus on operationalizing an NTL and evaluating the process and outcomes

An evaluation of advanced access in general practice

Aims: To evaluate ‘Advanced Access’ in general practice, and assess its impact on patients, practice organisation, activity, and staff.Objectives: To describe the range of strategies that general practices have employed to improve access to care To determine the impact of Advanced Access on the wait for an appointment, continuity of care, practice workload, and demand on other NHS services. To explore the perceptions of different groups of patients, including both users and non-users of services, about the accessibility of care and their satisfaction with access to care in relation to different models of organisation. To explore the trade-offs that patients make between speed of access, continuity of care and other factors when making an appointment in general practice. To explore the perceptions of general practitioners and receptionists about working with the NPDT and implementing changes to practice arrangements to improve access. To assess the impact of the above changes in practice organisation on staff job satisfaction and team climate.Method and results: This research was based on a comparison of 48 general practices, half of which operated Advanced Access appointment systems and half of which did not (designated ‘control’ practices). These practices were recruited from 12 representative Primary Care Trusts (PCTs). From within these 48 practices, eight (four Advanced Access and four control) were selected for in-depth case study using an ethnographic approach. The research was comprised of several component studies. These included: • A survey of all practices in 12 PCTs. Based on this we recruited the 24 Advanced Access and 24 control practices and the 8 case study practices. • An assessment of appointments available and patients seen, based on appointments records • An assessment of continuity of care based on patients’ records • Random phone calls to practices to assess ability to make an appointment by telephone • A questionnaire survey of patients attending the practices • A postal survey of patients who had not attended the surgery in the previous 12 months • A discrete choice experiment to explore trade-offs patients make between access and other factors • A survey of practice staff • Qualitative case studies in 8 practices • Interviews with PCT access facilitators The methods and results for each of these studies are described below, in relation to each of the research objectives.<br/

'PhysioDirect' telephone assessment and advice services for physiotherapy: protocol for a pragmatic randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Providing timely access to physiotherapy has long been a problem for the National Health Service in the United Kingdom. In an attempt to improve access some physiotherapy services have introduced a new treatment pathway known as PhysioDirect. Physiotherapists offer initial assessment and advice by telephone, supported by computerised algorithms, and patients are sent written self-management and exercise advice by post. They are invited for face-to-face treatment only when necessary. Although several such services have been developed, there is no robust evidence regarding clinical and cost-effectiveness, nor the acceptability of PhysioDirect.</p> <p>Methods/Design</p> <p>This protocol describes a multi-centre pragmatic individually randomised trial, with nested qualitative research. The aim is to determine the effectiveness, cost-effectiveness, and acceptability of PhysioDirect compared with usual models of physiotherapy based on patients going onto a waiting list and receiving face-to-face care. PhysioDirect services will be established in four areas in England. Adult patients in these areas with musculoskeletal problems who refer themselves or are referred by a primary care practitioner for physiotherapy will be invited to participate in the trial. About 1875 consenting patients will be randomised in a 2:1 ratio to PhysioDirect or usual care. Data about outcome measures will be collected at baseline and 6 weeks and 6 months after randomisation. The primary outcome is clinical improvement at 6 months; secondary outcomes include cost, waiting times, time lost from work and usual activities, patient satisfaction and preference. The impact of PhysioDirect on patients in different age-groups and with different conditions will also be examined.</p> <p>Incremental cost-effectiveness will be assessed in terms of quality adjusted life years in relation to cost.</p> <p>Qualitative methods will be used to explore factors associated with the success or failure of the service, the acceptability of PhysioDirect to patients and staff, and ways in which the service could be improved.</p> <p>Discussion</p> <p>It is still relatively unusual to evaluate new forms of service delivery using randomised controlled trials. By combining rigorous trial methods with economic analysis of cost-effectiveness and qualitative research this study will provide robust evidence to inform decisions about the widespread introduction of PhysioDirect services.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN55666618</p