842 research outputs found
Evaluation of NHS Direct ââreferralââ 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 callersâ 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 âprovide 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.â 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 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 nonÂsignificant. 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 partâgeneral practitioners' out of
hours services
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 âfairâ rather than
âmoderateâ or âgoodâ (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
Exploring the effect of changes to service provision on the use of unscheduled care in England: population surveys
Background
Unscheduled care is defined here as when someone seeks treatment or advice for a health problem without arranging to do so more than a day in advance. Recent health policy initiatives in England have focused on introducing new services such as NHS Direct and walk in centres into the unscheduled care system. This study used population surveys to explore the effect of these new services on the use of traditional providers of unscheduled care, and to improve understanding of help seeking behaviour within the system of unscheduled care.
Methods
Cross-sectional population postal surveys were undertaken annually over the five year period 1998 to 2002 in two geographical areas in England. Each year questionnaires were sent to 5000 members of the general population in each area.
Results
The response rate was 69% (33,602/48,883). Over the five year period 16% (5223/33602) 95%CI (15.9 to 16.1) of respondents had an unscheduled episode in the previous four weeks and this remained stable over time (p = 0.170). There was an increased use of telephone help lines over the five years, reflecting the change in service provision (p = 0.008). However, there was no change in use of traditional services over this time period. Respondents were most likely to seek help from general practitioners (GPs), family and friends, and pharmacists, used by 9.0%, 7.2% and 6.3% respectively of the 5815 respondents in 2002. Most episodes involved contact with a single service only: 7.0% (2363/33,602) of the population had one contact and 2% (662/33602) had three or more contacts per episode. GPs were the most frequent point of first contact with services.
Conclusion
Introducing new services to the provision of unscheduled care did not affect the use of traditional services. A large majority of the population continued to turn to their GP for unscheduled health care
Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study.
OBJECTIVE: To measure the effect of an urgent care telephone service NHS 111 on population perceptions of urgent care. DESIGN: Controlled before and after population survey, using quota sampling to identify 2000 respondents reflective of the age/sex profile of the general population. SETTING: England. 4 areas where NHS 111 was introduced, and 3 control areas where NHS 111 had yet to be introduced. PARTICIPANTS: 28â
071 members of the general population, including 2237 recent users of urgent care. INTERVENTION: NHS 111 offers advice to members of the general population seeking urgent care, recommending the best service to use or self-management. Policymakers introduced NHS 111 to improve access to urgent care. OUTCOMES MEASURES: The primary outcome was change in satisfaction with recent urgent care use 9â
months after the launch of NHS 111. Secondary outcomes were change in satisfaction with urgent care generally and with the national health service. RESULTS: The overall response rate was 28% (28â
071/100â
408). 8% (2237/28â
071) had used urgent care in the previous 3â
months. Of the 652 recent users of urgent care in the NHS 111 intervention areas, 9% (60/652) reported calling NHS 111 in the 'after' period. There was no evidence that the introduction of NHS 111 was associated with a changed perception of recent urgent care. For example, the percentage rating their experience as excellent remained at 43% (OR 0.97, 95% CI 0.69 to 1.37). Similarly, there was no change in population perceptions of urgent care generally (1.06, 95% CI 0.95 to 1.17) or the NHS (0.94, 95% CI 0.85 to 1.05) following the introduction of NHS 111. CONCLUSIONS: A new telephone triage service did not improve perceptions of urgent care or the health service. This could be explained by the small amount of NHS 111 activity in a large emergency and urgent care system
Acceptability of NHS 111 the telephone service for urgent health care: cross sectional postal survey of users' views
Background. In 2010, a new telephone service, NHS 111, was piloted to improve access to urgent
care in England. AÂ unique feature is the use of non-clinical call takers who triage calls with computerized
decision support and have access to clinical advisors when necessary.
Aim. To explore usersâ acceptability of NHS 111.
Design. Cross-sectional postal survey.
Setting. Four pilot sites in England.
Method. A postal survey of recent users of NHS 111.
Results. The response rate was 41% (1769/4265), with 49% offering written comments (872/1769).
Sixty-ive percent indicated the advice given had been very helpful and 28% quite helpful. The
majority of respondents (86%) indicated that they fully complied with advice. Seventy-three percent
was very satisied and 19% quite satisied with the service overall. Users were less satisied
with the relevance of questions asked, and the accuracy and appropriateness of advice given,
than with other aspects of the service. Users who were autorouted to NHS 111 from services such
as GP out-of-hours services were less satisied than direct callers.
Conclusion. In pilot services in the irst year of operation, NHS 111 appeared to be acceptable to the
majority of users. Acceptability could be improved by reassessing the necessity of triage questions used
and auditing the accuracy and appropriateness of advice given. User acceptability should be viewed in
the context of indings from the wider evaluation, which identiied that the NHS 111 pilot services did not
improve access to urgent care and indeed increased the use of emergency ambulance services
Impact of the urgent care telephone service NHS 111 pilot sites: a controlled before and after study
Objectives To measure the impact of the urgent care telephone service NHS 111 on the emergency and urgent care system.
Design Controlled before and after study using routine data.
Setting Four pilot sites and three control sites covering a total population of 3.6 million in England, UK.
Participants and data Routine data on 36â
months of use of emergency ambulance service calls and incidents, emergency department attendances, urgent care contacts (general practice (GP) out of hours, walk in and urgent care centres) and calls to the telephone triage service NHS direct.
Intervention NHS 111, a new 24â
h 7â
day a week telephone service for non-emergency health problems, operated by trained non-clinical call handlers with clinical support from nurse advisors, using NHS Pathways software to triage calls to different services and home care.
Main outcomes Changes in use of emergency and urgent care services.
Results NHS 111 triaged 277â
163 calls in the first year of operation for a population of 1.8 million. There was no change overall in emergency ambulance calls, emergency department attendances or urgent care use. There was a 19.3% reduction in calls to NHS Direct (95% CI â24.6% to â14.0%) and a 2.9% increase in emergency ambulance incidents (95% CI 1.0% to 4.8%). There was an increase in activity overall in the emergency and urgent care system in each site ranging 4.7â12%/month and this remained when assuming that NHS 111 will eventually take all NHS Direct and GP out of hours calls.
Conclusions In its first year of operation in four pilot sites NHS 111 did not deliver the expected system benefits of reducing calls to the 999 ambulance service or shifting patients to urgent rather than emergency care. There is potential that this type of service increases overall demand for urgent care
Empirical constraints on the origin of fast radio bursts: volumetric rates and host galaxy demographics as a test of millisecond magnetar connection
The localization of the repeating FRB 121102 to a low-metallicity dwarf
galaxy at , and its association with a quiescent radio source,
suggests the possibility that FRBs originate from magnetars, formed by the
unusual supernovae in such galaxies. We investigate this via a comparison of
magnetar birth rates, the FRB volumetric rate, and host galaxy demographics. We
calculate average volumetric rates of possible millisecond magnetar production
channels such as superluminous supernovae (SLSNe), long and short gamma-ray
bursts (GRBs), and general magnetar production via core-collapse supernovae.
For each channel we also explore the expected host galaxy demographics using
their known properties. We determine for the first time the number density of
FRB emitters (the product of their volumetric birthrate and lifetime), Gpc, assuming that FRBs are predominantly emitted
from repetitive sources similar to FRB 121102 and adopting a beaming factor of
0.1. By comparing rates we find that production via rare channels (SLSNe, GRBs)
implies a typical FRB lifetime of 30-300 yr, in good agreement with
other lines of argument. The total energy emitted over this time is consistent
with the available energy stored in the magnetic field. On the other hand, any
relation to magnetars produced via normal core-collapse supernovae leads to a
very short lifetime of 0.5yr, in conflict with both theory and
observation. We demonstrate that due to the diverse host galaxy distributions
of the different progenitor channels, many possible sources of FRB birth can be
ruled out with host galaxy identifications. Conversely, targeted
searches of galaxies that have previously hosted decades-old SLSNe and GRBs may
be a fruitful strategy for discovering new FRBs and related quiescent radio
sources, and determining the nature of their progenitors
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