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Al-Shroby WA, Sohaibani IS, AlShlash NK, Alsalamah NA, Alhraiwila NJ. Factors influencing telehealth awareness, utilization, and satisfaction in KSA: A national population-based study. J Taibah Univ Med Sci 2024; 19:677-686. [PMID: 38860261 PMCID: PMC11163165 DOI: 10.1016/j.jtumed.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 03/19/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Background Telehealth involves delivering healthcare remotely through digital platforms such as telephone and video calls. Use of telehealth surged during the COVID-19 pandemic because of the need for contactless healthcare. The Saudi Ministry of Health established the "937 telephone medical consultation call center" almost 10 years ago. Objectives The aim of this study was to examine public awareness of, utilization of, and satisfaction with the 937 call center service, and to assess associated factors. Materials and methods This national community-based, cross-sectional study was conducted through multistage sampling with proportional allocation from 20 health directorates. Participants were selected from the general population in public places and were interviewed with a validated questionnaire. Results Of 7951 approached individuals, 7692 agreed to participate (response rate 96.7%). Seventy-eight percent of participants were aware of the 937 service, and 56.4% had previously used the service. Most (86%) users were satisfied with the service. Long waiting times were the most frequent reason (46.6%) for dissatisfaction. In multivariable analysis, service awareness and utilization were both significantly associated with having higher education (aOR 4.03, 95%CI: 3.17-5.12 and aOR 3.42, 95%CI: 2.64-4.42, respectively). Positive impressions of telephone medical consultation services, Saudi nationality, having children, having medical insurance, and having a history of chronic disease were significantly associated with awareness of, utilization of, and satisfaction with the service. Conclusion The study revealed high awareness of, utilization of, and satisfaction with the 937 telephone medical consultation call center, thus suggesting increased public acceptance of the service. Moreover, the study identified socio-demographic factors influencing public awareness of, utilization of, and satisfaction with telehealth. Further studies are required to increase understanding of the facilitators of, and barriers to, the use of service among various population groups.
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Affiliation(s)
- Walid A.A. Al-Shroby
- Deputyship of Public Health, Ministry of Health, KSA
- Public Health & Community Medicine Department, Faculty of Medicine, Beni-Suef University, Egypt
| | | | - Nora K. AlShlash
- Assistant Deputyship for Preventive Health, Ministry of Health, KSA
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Turnbull J, MacLellan J, Churruca K, Ellis LA, Prichard J, Browne D, Braithwaite J, Petter E, Chisambi M, Pope C. A multimethod study of NHS 111 online. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-104. [PMID: 37464813 DOI: 10.3310/ytrr9821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background NHS 111 online offers 24-hour access to health assessment and triage. Objectives This study examined pathways to care, differential access and use, and workforce impacts of NHS 111 online. This study compared NHS 111 with Healthdirect (Haymarket, Australia) virtual triage. Design Interviews with 80 staff and stakeholders in English primary, urgent and emergency care, and 41 staff and stakeholders associated with Healthdirect. A survey of 2754 respondents, of whom 1137 (41.3%) had used NHS 111 online and 1617 (58.7%) had not. Results NHS 111 online is one of several digital health-care technologies and was not differentiated from the NHS 111 telephone service or well understood. There is a similar lack of awareness of Healthdirect virtual triage. NHS 111 and Healthdirect virtual triage are perceived as creating additional work for health-care staff and inappropriate demand for some health services, especially emergency care. One-third of survey respondents reported that they had not used any NHS 111 service (telephone or online). Older people and those with less educational qualifications are less likely to use NHS 111 online. Respondents who had used NHS 111 online reported more use of other urgent care services and make more cumulative use of services than those who had not used NHS 111 online. Users of NHS 111 online had higher levels of self-reported eHealth literacy. There were differences in reported preferences for using NHS 111 online for different symptom presentations. Conclusions Greater clarity about what the NHS 111 online service offers would allow better signposting and reduce confusion. Generic NHS 111 services are perceived as creating additional work in the primary, urgent and emergency care system. There are differences in eHealth literacy between users and those who have not used NHS 111 online, and this suggests that 'digital first' policies may increase health inequalities. Limitations This research bridged the pandemic from 2020 to 2021; therefore, findings may change as services adjust going forward. Surveys used a digital platform so there is probably bias towards some level of e-Literacy, but this also means that our data may underestimate the digital divide. Future work Further investigation of access to digital services could address concerns about digital exclusion. Research comparing the affordances and cost-benefits of different triage and assessment systems for users and health-care providers is needed. Research about trust in virtual assessments may show how duplication can be reduced. Mixed-methods studies looking at outcomes, impacts on work and costs, and ways to measure eHealth literacy, can inform the development NHS 111 online and opportunities for further international shared learning could be pursued. Study registration This study is registered at the research registry (UIN 5392). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jennifer MacLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jane Prichard
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Emily Petter
- NHS Hampshire, Southampton and Isle of Wight Clinical Commissioning Group, Winchester, UK
| | - Matthew Chisambi
- Imperial College Health Partners, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Aljabri D, Albinali H. Public awareness and use of 997 emergency medical service phone number during the COVID-19 pandemic. Front Public Health 2022; 10:937202. [PMID: 36262224 PMCID: PMC9574394 DOI: 10.3389/fpubh.2022.937202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023] Open
Abstract
Background Emergency medical services (EMSs) are an important element of the healthcare system as it provides an opportunity to respond to critical medical conditions and save people's lives. In Saudi Arabia, EMS is offered via the EMS phone number "997" and mobile application "Asefny". Methods This was an observational cross-sectional survey study exploring public awareness and use of the EMS phone number during the COVID-19 pandemic in Saudi Arabia. A bivariate analysis was performed to investigate factors affecting awareness and use of the EMS phone number and to compare the EMS acceptance to transport and timelines of ambulance arrival between requests made via the "997" EMS phone number and the "Asefny" mobile application during the country's emergency lockdown. Results A total of 805 participants were included in the analysis, where 66% reported awareness of the EMS phone number and 75% of them accurately identified the nature of the service provided by dialing the number. The men who participated, those with a bachelor's degree, with children, and with chronic conditions were more aware of the EMS phone number compared to the other participants. Of the total sample, 46.7% used EMS phone numbers at least one time (ever users). During the COVID-19 lockdown, the EMS accepted to transport 87% of the calls made by 997 phone number and 56.2% of the mobile application requests (P < 0.00). The ambulance arrived in ≤ 8 min in 53.6% of the 997 phone calls and 35.5% of the Asefny mobile requests (P < 0.00). Conclusions Findings showed commendable levels of awareness and the use of EMS phone numbers. However, the results suggest room for improvement by developing promotional and educational campaigns inspired by the factors identified as influential on both awareness and use. Mobile applications in EMS are promising to improve prehospital emergency service accessibility, which needs to be further investigated to assess its impact on the public health informatics experience.
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Kim HJ, Jang SN, Lim JY. Service Demand for and Awareness of a Primary Healthcare Pilot Project for People With Disabilities. J Korean Med Sci 2022; 37:e241. [PMID: 35916049 PMCID: PMC9344037 DOI: 10.3346/jkms.2022.37.e241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study investigated the demand for and awareness of a primary healthcare pilot project for people with disabilities; it also sought to identify relevant determinants for demand and awareness using Andersen's behavioral model of health service use. METHODS This study is a secondary analysis of data from the population-based survey conducted in Gyeonggi Regional Health & Medical Center for People with Disabilities. The data was designed with quota random sampling based on the population with disabilities in each district (city [si] and county [gun]) across the Gyeonggi province (do) to evaluate the health and healthcare accessibility of the disabled people living in the Gyeonggi province. The data was collected through the mobile-based survey of 1,140 people with disabilities living in Gyeonggi-do between March 2021 and June 2021. RESULTS Awareness of the service (12.1%) was remarkably low, while the demand (80.5%) was high. The gap between respondents who needed the service but were unaware of it differed according to age, education, activities of daily living, health information sources, chronic disease, depression, subjective health status, and unmet healthcare needs. Chronic disease (odds ratio [OR], 1.86; P = 0.001) and an unmet need for medical care (OR, 2.30; P = 0.002) had significant influences on demand for the service. Furthermore, living alone (OR, 0.42; P = 0.023), medical aid program beneficiary status (OR, 2.10; P = 0.020), access to health information from health service centers (OR, 4.00; P = 0.002), chronic disease (OR, 1.68; P = 0.043), severity of disability (OR, 1.78; P = 0.025), and subjective health status (OR, 4.51; P < 0.001) significantly affected awareness of the program. CONCLUSION Chronic disease and an unmet need for medical care were key determinants of service demand, while the severity of disability was not. Thus, there is a need to review the initiative that defines service beneficiaries as people with severe disabilities. Policy makers should consider advertising programs to improve service awareness among people with disabilities.
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Affiliation(s)
- Hye-Jin Kim
- Gyeonggi Regional Health & Medical Center for People with Disabilities, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Jae-Young Lim
- Gyeonggi Regional Health & Medical Center for People with Disabilities, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Nakubulwa MA, Greenfield G, Pizzo E, Magusin A, Maconochie I, Blair M, Bell D, Majeed A, Sathyamoorthy G, Woodcock T. To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study. PLoS One 2022; 17:e0267052. [PMID: 35446886 PMCID: PMC9022858 DOI: 10.1371/journal.pone.0267052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics. Caller’s action is ‘compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30–59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls. Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service. This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote healthcare services going forward.
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Affiliation(s)
- Mable Angela Nakubulwa
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Andreas Magusin
- NHS North and East London Commissioning Support Unit, London, United Kingdom
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary’s Hospital–Imperial College NHS Healthcare Trust, London, United Kingdom
| | - Mitch Blair
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Derek Bell
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Ganesh Sathyamoorthy
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Thomas Woodcock
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
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Al-Rayes SA, Alumran A, Aljabri D, Aljaffary A, Aldoukhi E, Alahmedalyousif Z, Al Madani R. Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study. J Med Internet Res 2021; 23:e27618. [PMID: 34156963 PMCID: PMC8330632 DOI: 10.2196/27618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings. Objective This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA. Methods In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic. Results The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants’ age, education level, having children, or having any chronic disease. Conclusions Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population.
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Affiliation(s)
- Saja A Al-Rayes
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alumran
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Duaa Aljabri
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Afnan Aljaffary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ethar Aldoukhi
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Alahmedalyousif
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Reem Al Madani
- Risk Management Unit, Directorate of Quality and Safety, King Fahah Hospital of the University, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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A service evaluation and stakeholder perspectives of an innovative digital minor illness referral service from NHS 111 to community pharmacy. PLoS One 2020; 15:e0230343. [PMID: 32191744 PMCID: PMC7082053 DOI: 10.1371/journal.pone.0230343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/26/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction The management of minor conditions represents a significant burden for urgent and emergency care services and reduces the capacity to provide specialist care for higher acuity healthcare need. A pilot Digital Minor Illness Service (DMIRS) was commenced in the North East of England in December 2017 to feasibility test the NHS 111 referral to community pharmacy for patients presenting with minor conditions. Objectives A formative evaluation of the service activity data and qualitative investigation of stakeholders involved in the service design, management, delivery and use, aims to present and investigate the service outcomes. Method Routine service activity data was evaluated during Jan–Dec 2018 to investigate the demographics of patients included in the service; the presenting conditions; and how those referrals were managed by community pharmacies. Semi-structured interviews with NHS 111 call handlers, project team members, community pharmacists and patients were undertaken to investigate the design, management, implementation and delivery of the service. Results 13,246 NHS 111 patient calls were referred to community pharmacy during the evaluative period. The most common presenting conditions were acute pain (n = 1144, 8.6%) and cough (n = 887, 6.7%). A large volume of complaints (47.1%, 6233) were resolved in community pharmacy. Stakeholders explained the structured approach to service design, organisation and implementation facilitated successful delivery and management. Patients reported positive experiences with accessing care via DMIRS. Conclusions DMIRS demonstrated that patients could be referred to community pharmacy for the management of minor conditions, shifting a burden away from urgent and emergency care. The service data provides key information for further optimisation of service design, and stakeholder training and awareness. The service was acceptable and valued by patients. Evidence from the DMIRS pilot has been utilised to inform recent national healthcare policy and practice around the management of minor conditions within the urgent and emergency care setting.
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Al-rayes SA, Aldossary H, Aldoukhi E, Alahmedalyousif Z, Aldawood G, Alumran A. The awareness and utilization of 937-telephone health services in Saudi Arabia: Cross-sectional survey study. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Kaminsky E, Höglund AT. Swedish Healthcare Direct managers' views on gender (in)equity: applying a conceptual model. Int J Equity Health 2019; 18:114. [PMID: 31340821 PMCID: PMC6657095 DOI: 10.1186/s12939-019-1011-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/25/2019] [Indexed: 11/18/2022] Open
Abstract
Background Although Swedish legislation prescribes equity in healthcare, inequitable healthcare is repeatedly reported in Sweden. Telephone nursing is suggested to promote equitable healthcare, making it just one call away for anyone, at any time, irrespective of distance. However, paediatric health calls reflect that male parents are referred to other health services twice as much as female parents are. Regarding equity in healthcare, telephone nurses have expressed a continuum from Denial and Defence to Openness and Awareness. To make a change, Action is also needed, within organizational frames. The aim here was thus to investigate Swedish Healthcare Direct managers’ views on gender (in)equity in healthcare through the application of a conceptual model, developed based on empirical Swedish Healthcare Direct telephone RN data, as a baseline measure at the service’s national implementation. Methods All Swedish Healthcare Direct managers were interviewed during the period March–May 2012. They were asked how they view equitable healthcare, and how they work to achieve it. A conceptual model for attaining equity in healthcare, including Denial, Defence, Openness, Awareness and Action, was used in a deductive thematic analysis of the interview data. Results The five model concepts – Denial; Defence; Openness; Awareness and Action – were found in a variety of combinations in the manager interviews. Denial and Defence were mentioned to a higher extent than Openness and Awareness. Several informants denied inequity, arguing that the decision support tool prevented this. However, those who primarily expressed Denial and Defence were also open to learning more on the subject. Action was only mentioned twice in the informants’ answers, and then only implicitly. Conclusion Although a majority of the interviewed managers expressed a lack of awareness of (in)equity in healthcare, they also expressed an openness to learning more. While this may reflect a desire to show political correctness, it also points to the need for educational training in order to increase the awareness of (in)equity in healthcare among healthcare managers. Future follow up measurements will reveal if this has happened.
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Affiliation(s)
- Elenor Kaminsky
- Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden.
| | - Anna T Höglund
- Department of Public Health and Caring Sciences, Box 564, SE-751 22, Uppsala, Sweden
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Kaminsky E, Röing M, Björkman A, Holmström IK. Telephone nursing in Sweden: A narrative literature review. Nurs Health Sci 2017; 19:278-286. [DOI: 10.1111/nhs.12349] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/14/2017] [Accepted: 03/02/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Elenor Kaminsky
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- School of Health, Care and Social Welfare; Mälardalen University; Västerås Sweden
| | - Marta Röing
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Annica Björkman
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Department of Health and Caring Sciences; University of Gävle; Gävle Sweden
| | - Inger K. Holmström
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- School of Health, Care and Social Welfare; Mälardalen University; Västerås Sweden
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Turnbull J, Prichard J, Pope C, Brook S, Rowsell A. Risk work in NHS 111: the everyday work of managing risk in telephone assessment using a computer decision support system. HEALTH RISK & SOCIETY 2017. [DOI: 10.1080/13698575.2017.1324946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Joanne Turnbull
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Prichard
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Simon Brook
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Rowsell
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Middleton A, Woodward A, Gunn J, Bassilios B, Pirkis J. How do frequent users of crisis helplines differ from other users regarding their reasons for calling? Results from a survey with callers to Lifeline, Australia's national crisis helpline service. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1041-1049. [PMID: 27862572 DOI: 10.1111/hsc.12404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 06/06/2023]
Abstract
Crisis helplines are designed to provide short-term support to people in an immediate crisis. However, there is a group of users who call crisis helplines frequently over an extended period of time. The reasons for their ongoing use remain unclear. The aim of this study was to investigate the differences in the reasons for calling between frequent and other users of crisis helplines. This was achieved by examining the findings from a brief survey completed by callers to Lifeline Australia at the end of their call between February and July 2015. In the survey, callers reported on their socio-demographics, reasons for their current call and number of calls made in the past month. Survey respondents were categorised as frequent, episodic and one-off users, and analyses were conducted using ordered logistic regression. Three hundred and fifteen callers completed the survey, which represented 57% of eligible callers. Twenty-two per cent reported calling 20 times or more in the past month (frequent users), 51% reported calling between 2 and 19 times (episodic users) and 25% reported calling once (one-off users). Two per cent were unable to recall the number of calls they made in the past month. Frequent users reported similar reasons for calling as other users but they were more likely to call regularly to talk about their feelings [OR = 6.0; 95% CI: 3.7-9.8]. This pattern of service use is at odds with the current model of care offered by crisis helplines which is designed to provide one-off support. There is a need to investigate further the factors that drive frequent users to call crisis helplines regularly.
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Affiliation(s)
- Aves Middleton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Alan Woodward
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Lifeline Research Foundation, Canberra, ACT, Australia
| | - Jane Gunn
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Carlton, Victoria, Australia
| | - Bridget Bassilios
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Atherton H, Ziebland S. What do we need to consider when planning, implementing and researching the use of alternatives to face-to-face consultations in primary healthcare? Digit Health 2016; 2:2055207616675559. [PMID: 29942570 PMCID: PMC6001190 DOI: 10.1177/2055207616675559] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/23/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives Communications technologies are variably utilised in healthcare. Policymakers globally have espoused the potential benefits of alternatives to face-to-face consultations, but research is in its infancy. The aim of this essay is to provide thinking tools for policymakers, practitioners and researchers who are involved in planning, implementing and evaluating alternative forms of consultation in primary care. Methods We draw on preparations for a focussed ethnographic study being conducted in eight general practice settings in the UK, knowledge of the literature, qualitative social science and Cochrane reviews. In this essay we consider different types of patients, and also reflect on how the work, practice and professional identities of different members of staff in primary care might be affected. Results Elements of practice are inevitably lost when consultations are no longer face-to-face, and we know little about the impact on core aspects of the primary care relationship. Resistance to change is normal and concerns about the introduction of alternative methods of consultation are often expressed using proxy reasons; for example, concerns about patient safety. Any planning or research in the field of new technologies should be attuned to the potential for unintended consequences. Conclusions Implementation of alternatives to the face-to-face consultation is more likely to succeed if approached as co-designed initiatives that start with the least controversial and most promising changes for the practice. Researchers and evaluators should explore actual experiences of the different consultation types amongst patients and the primary care team rather than hypothetical perspectives.
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Affiliation(s)
- Helen Atherton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford Radcliffe Observatory Quarter, Oxford, UK
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Knowles E, O'Cathain A, Turner J, Nicholl J. Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study. BMJ Open 2016; 6:e011846. [PMID: 27742622 PMCID: PMC5073559 DOI: 10.1136/bmjopen-2016-011846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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 28 071 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 9 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% (28 071/100 408). 8% (2237/28 071) had used urgent care in the previous 3 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.
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Affiliation(s)
- E Knowles
- ScHARR, University of Sheffield, Sheffield, UK
| | - A O'Cathain
- ScHARR, University of Sheffield, Sheffield, UK
| | - J Turner
- ScHARR, University of Sheffield, Sheffield, UK
| | - J Nicholl
- ScHARR, University of Sheffield, Sheffield, UK
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Nazar H, Nazar Z, Simpson J, Yeung A, Whittlesea C. Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS). BMJ Open 2016; 6:e009736. [PMID: 26787252 PMCID: PMC4735177 DOI: 10.1136/bmjopen-2015-009736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Service and stakeholder evaluation of an NHS-funded service providing out-ofhours (OOH) emergency repeat medications to patients self-presenting at community pharmacies. SETTING Community pharmacies across the North East of England accredited to provide this service. PARTICIPANTS Patients self-presenting to community pharmacies during OOH periods with emergency repeat medication supply requests. INTERVENTION Community pharmacists assessed each request for clinical appropriateness and when suitable provide an emergency repeat medication supply, with additional pharmaceutical advice and services if required. PRIMARY OUTCOMES Number of emergency repeat medication supplies, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist and patient satisfaction. RESULTS A total of 2485 patients were managed across 227 community pharmacies (15 December 2014 to 7 April 2015). Most patients presented on Saturdays, with increased activity over national holidays. Older age was associated with increased service use. Of the 3226 medications provided, 439 were classified as high risk. Patients found this service easy to access and were willing to access the community pharmacy in the future for medication-related issues. In the absence of this service, 50% of patients would have missed their medication(s) until they saw their doctor and a further 46% would have accessed an alternative service. The cost of National Health Service (NHS) service(s) for patients who would have accessed an alternative OOH service was estimated as 37 times that of the community pharmacy service provided. Community pharmacists were happy to provide this service despite increased consultation times and workload. CONCLUSIONS Community pharmacists were able to manage patients' OOH requests for emergency repeat medication and patients were happy with the service provided. Since the service cost was favourable when compared with alternative OOH services, it would be a viable option to reduce the workload on the wider NHS.
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Affiliation(s)
- Hamde Nazar
- School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees, UK
| | - Zachariah Nazar
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Jill Simpson
- Clinical Strategy, NHS England North—Cumbria and the North East, Durham, UK
| | - Andre Yeung
- Senior Specialist Pharmacist Advisor, Northumberland, Tyne and Wear Local Pharmacy Network, Northumberland, UK
| | - Cate Whittlesea
- School of Medicine, Pharmacy and Health, Durham University, Stockton-On-Tees, UK
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Turner J, Coster J, Chambers D, Cantrell A, Phung VH, Knowles E, Bradbury D, Goyder E. What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03430] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundIn 2013 NHS England set out its strategy for the development of an emergency and urgent care system that is more responsive to patients’ needs, improves outcomes and delivers clinically excellent and safe care. Knowledge about the current evidence base on models for provision of safe and effective urgent care, and the gaps in evidence that need to be addressed, can support this process.ObjectiveThe 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.Data sourcesMEDLINE, EMBASE, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Web of Science.MethodsWe have conducted a rapid, framework-based, evidence synthesis approach. Five separate reviews linked to themes in the NHS England review were conducted. One general and five theme-specific database searches were conducted for the years 1995–2014. Relevant systematic reviews and additional primary research papers were included and narrative assessment of evidence quality was conducted for each review.ResultsThe review was completed in 6 months. In total, 45 systematic reviews and 102 primary research studies have been included across all five reviews. The key findings for each review are as follows: (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 the 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 the number of transports to hospital, making safe decisions about the need for transport and delivering acceptable, cost-effective care out of hospital; (4) emergency department (ED) – the evidence on co-location of general practitioner services with EDs indicates that 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; and (5) there is no empirical evidence to support the design and development of urgent care networks.LimitationsAlthough 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.ConclusionsThe evidence gaps of most relevance to the delivery of services are (1) a requirement for 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 the 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.FundingThe National Institute for Health Research Health Services and Delivery Research Programme.
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Affiliation(s)
- Janette Turner
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Joanne Coster
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- College of Social Science, University of Lincoln, Lincoln, UK
| | - Emma Knowles
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Turbitt E, Freed GL. Use of a telenursing triage service by Victorian parents attending the emergency department for their child's lower urgency condition. Emerg Med Australas 2015; 27:558-562. [DOI: 10.1111/1742-6723.12477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Erin Turbitt
- Centre for Health Policy, Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Gary L Freed
- Centre for Health Policy, Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
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