258 research outputs found
Impact of NHS Direct on demand for immediate care: observational study
OBJECTIVES: To quantify the impact of NHS Direct on
the use of accident and emergency, ambulance, and
general practitioner cooperative services.
DESIGN: Observational study of trends in use of NHS
Direct and other immediate care services over 24
months spanning introduction of NHS Direct.
Setting Three areas in England in first wave of
introduction of NHS Direct, and six nearby general
practitioner cooperatives as controls.
SUBJECTS: All contacts with these immediate care
services.
MAIN OUTCOME MEASURES: Changes in trends in use
after introduction of NHS Direct.
Results NHS Direct received about 68 500 calls from
a population of 1.3 million in its first year of
operation, of which 72% were out of hours and 22%
about a child aged under 5 years. Changes in trends
in use of accident and emergency departments and
ambulance services after introduction of NHS Direct
were small and nonĀsignificant. Changes in trends in
use of general practitioner cooperatives were also
small but significant, from an increase of 2.0% a
month before introduction of NHS Direct to - 0.8%
afterwards (relative change - 2.9% (95% confidence
interval - 4.2% to - 1.5%)). This reduction in trend
was significant both for calls handled by telephone
advice alone and for those resulting in direct contact
with a doctor. In contrast, the six control cooperatives
showed no evidence of change in trend; an increase of
0.8% a month before NHS Direct and 0.9% after
(relative change 0.1% ( - 0.9% to 1.1%)).
CONCLUSION: In its first year NHS Direct did not reduce
the pressure on NHS immediate care services,
although it may have restrained increasing demand
on one important partāgeneral practitioners' out of
hours services
Evaluation of NHS Direct āāreferralāā to community pharmacists
OBJECTIVES: To evaluate a pilot scheme of referrals from a nurse-led telephone helpline (NHS
Direct) to community pharmacists.
METHODS: A multi-method approach, including analysis of routine data from NHS Direct, postal
surveys of NHS Direct callers, analysis of anonymised transcripts of calls, a postal survey of callers
referred to pharmacists, and face-to-face interviews with NHS Direct nurses.
SETTING: Essex, Barking and Havering.
KEY FINDINGS: During the first three months of the pilot scheme, 6% (1,995/31,674) of NHS Direct
calls triaged by nurses were logged as referred to pharmacists. This built on an existing foundation of
informal referral to pharmacists of 4%. There was no measurable change in callersā views of the
helpfulness of advice, enablement, or caller satisfaction associated with the scheme. Conditions sent
to pharmacists included skin rash, cough, sore throat, stomach pain, and vomiting and/or diarrhoea.
86% (54/63) of callers referred to pharmacists during the scheme felt the referral was very or quite
appropriate and 75% (48/64) attempted to contact a pharmacist. In general, those who did so found
the experience a positive one: 65% (31/48) spoke to the pharmacist, and 80% (28/35) of people
expressing an opinion were satisfied with the advice offered, but the lack of privacy in the pharmacy
was of some concern. Although routine data indicated high usage of the scheme, nurse referral of
callers to pharmacists declined over time. Their initial enthusiasm diminished due to concerns about
the appropriateness of guidelines, their lack of understanding of the rationale behind some referrals,
and the lack of feedback about the appropriateness of their referrals.
CONCLUSIONS: The evaluation of the pilot scheme has generated a range of recommendations for
the wider national roll-out of the scheme, including revision of the guidelines and review of NHS
Direct nurse training for referral to pharmacy. NHS Direct and pharmacists should consider how to
strengthen the system of pharmacist feedback to NHS Direct
Integrating community pharmacy and NHS Direct - pharmacists' views
AIM:To establish the views of community pharmacists on NHS Direct and its forthcoming integration with community pharmacy.
DESIGN: Postal questionnaire survey.
SUBJECTS AND SETTING: Pharmacists working in community pharmacies within the area of the NHS Direct Pharmacy pilot scheme - Essex, Barking and Havering.
RESULTS: The response rate to the postal survey was 72% (263/364). Most pharmacies were generally supportive of NHS Direct (80%) and the pharmacy scheme in principle (83%), although their experience of the scheme in practice was limited. Perhaps because of this, the majority of pharmacists were unsure as to whether NHS Direct was referring appropriately, or whether the pharmacy would be able to meet the needs of patients without further referral. Almost half believed that patients referred by NHS Direct should be seen in a quiet area, away from the counter. Over two-thirds of pharmacists were willing to accommodate an NHS Direct information point in their pharmacy, although space was an issue.
CONCLUSION: Overall the results of this study suggested that community pharmacists welcome their increasing involvement in the developing immediate care system. As the Government commitment in the NHS plan to integrate community pharmacy with NHS Direct becomes a reality across England and Wales over coming months the implications for pharmacists, in terms of workload and the adequacy of premises, will become clearer. Careful audit of the operation of the scheme will be essential
How helpful is NHS Direct? Postal survey of callers
NHS Direct, the new 24 hour telephone advice line
staffed by nurses, was established to āprovide easier
and faster information for people about health, illness
and the NHS so that they are better able to care for
themselves and their families.ā In March 1998, three
first wave sites started in Lancashire, Milton Keynes,
and Northumbria. As part of an extensive evaluation of
this new service, we surveyed callers to determine how
helpful they found the advice offered
Impact of NHS Direct on other services: the characteristics and origins of its nurses
OBJECTIVE:: To characterise the NHS Direct nurse workforce and estimate the impact of NHS Direct on the staffing of other NHS nursing specialties.
METHOD: A postal survey of NHS Direct nurses in all 17 NHS Direct call centres operating in June 2000.
RESULTS: The response rate was 74% (682 of 920). In the three months immediately before joining NHS Direct, 20% (134 of 682, 95% confidence intervals 17% to 23%) of respondents had not been working in the NHS. Of the 540 who came from NHS nursing posts, one fifth had come from an accident and emergency department or minor injury unit (110 of 540), and one in seven from practice nursing (75 of 540). One in ten (65 of 681) nurses said that previous illness, injury, or disability had been an important reason for deciding to join NHS Direct. Sixty two per cent (404 of 649) of nurses felt their job satisfaction and work environment had improved since joining NHS Direct.
CONCLUSION: The NHS Direct nurse workforce currently constitutes a small proportion (about 0.5%) of all qualified nurses in the NHS, although it recruits relatively experienced and well qualified nurses more heavily from some specialties, such as accident and emergency nursing, than others. However, its overall impact on staffing in any one specialty is likely to be small. NHS Direct has succeeded in providing employment for some nurses who might otherwise be unable to continue in nursing because of disability
NHS Direct: consistency of triage outcomes
OBJECTIVES: To examine the consistency of triage outcomes by nurses using four types of computerised
decision support software in NHS Direct.
METHODS: 119 scenarios were constructed based on calls to ambulance services that had been
assigned the lowest priority category by the emergency medical dispatch systems in use. These
scenarios were presented to nurses working in four NHS Direct call centres using different computerised
decision support software, including the NHS Clinical Assessment System.
RESULTS: The overall level of agreement between the nurses using the four systems was āfairā rather than
āmoderateā or āgoodā (k=0.375, 95% CI: 0.34 to 0.41). For example, the proportion of calls triaged
to accident and emergency departments varied from 22% (26 of 119) to 44% (53 of 119). Between
21% (25 of 119) and 31% (37 of 119) of these low priority ambulance calls were triaged back to the
999 ambulance service. No system had both high sensitivity and specificity for referral to accident and
emergency services.
CONCLUSIONS: There were large differences in outcome between nurses using different software systems
to triage the same calls. If the variation is primarily attributable to the software then standardising on a
single system will obviously eliminate this. As the calls were originally made to ambulance services and
given the lowest priority, this study also suggests that if, in the future, ambulance services pass such
calls to NHS Direct then at least a fifth of these may be passed back unless greater sensitivity in the
selection of calls can be achieved
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