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Effect of a National Urgent Care Telephone Triage Service on Population Perceptions of Urgent Care Provision: Controlled Before and After Study

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Effect of a National Urgent Care Telephone Triage Service on Population Perceptions of Urgent Care Provision: Controlled Before and After Study This is a repository copy of Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study.. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/106733/ Version: Published Version Article: Knowles, E., O'Cathain, A., Turner, J. et al. (1 more author) (2016) Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study. BMJ Open, 6 (10). e011846-e011846. ISSN 2044-6055 https://doi.org/10.1136/bmjopen-2016-011846 Reuse This article is distributed under the terms of the Creative Commons Attribution-NonCommercial (CC BY-NC) licence. This licence allows you to remix, tweak, and build upon this work non-commercially, and any new works must also acknowledge the authors and be non-commercial. You don’t have to license any derivative works on the same terms. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Downloaded from http://bmjopen.bmj.com/ on November 2, 2016 - Published by group.bmj.com Open Access Research Effect of a national urgent care telephone triage service on population perceptions of urgent care provision: controlled before and after study E Knowles, A O’Cathain, J Turner, J Nicholl To cite: Knowles E, ABSTRACT ’ Strengths and limitations of this study O Cathain A, Turner J, et al. Objective: To measure the effect of an urgent care Effect of a national urgent telephone service NHS 111 on population perceptions ▪ care telephone triage service This is a large population survey undertaken to of urgent care. on population perceptions of measure whether a new way of managing urgent urgent care provision: Design: Controlled before and after population survey, care changed people’s perceptions of urgent controlled before and after using quota sampling to identify 2000 respondents care. study. BMJ Open 2016;6: reflective of the age/sex profile of the general ▪ The controlled before and after design is robust e011846. doi:10.1136/ population. for measuring change. bmjopen-2016-011846 Setting: England. 4 areas where NHS 111 was ▪ It uses an innovative way of identifying recent introduced, and 3 control areas where NHS 111 had users of urgent care and their views of the whole ▸ Prepublication history for yet to be introduced. episode of care they experienced. this paper is available online. Participants: 28 071 members of the general ▪ The telephone survey has a low response rate, To view these files please population, including 2237 recent users of urgent care. although it is similar in all areas in both time visit the journal online Intervention: NHS 111 offers advice to members of periods. (http://dx.doi.org/10.1136/ the general population seeking urgent care, ▪ It is possible that the lack of change was due to bmjopen-2016-011846). recommending the best service to use or self- the insensitivity of the questionnaire to identify Received 24 March 2016 management. Policymakers introduced NHS 111 to change, although it was developed and validated Revised 12 September 2016 improve access to urgent care. for measuring change in user perceptions of Accepted 20 September 2016 Outcomes measures: The primary outcome was emergency and urgent care systems. 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. In 2011, a new telephone triage service The overall response rate was 28% (28 071/ called NHS 111 was introduced in some Results: 7 100 408). 8% (2237/28 071) had used urgent care in parts of England. The service offers advice the previous 3 months. Of the 652 recent users of to members of the general population urgent care in the NHS 111 intervention areas, 9% seeking urgent care. It is aimed at people (60/652) reported calling NHS 111 in the ‘after’ period. having healthcare episodes where the situ- There was no evidence that the introduction of NHS ation is not life threatening. The service 111 was associated with a changed perception of employs non-clinical call handlers to direct recent urgent care. For example, the percentage rating callers to the most appropriate service or their experience as excellent remained at 43% offers self-management advice. Call handlers (OR 0.97, 95% CI 0.69 to 1.37). Similarly, there was use computerised software to triage calls, no change in population perceptions of urgent care generally (1.06, 95% CI 0.95 to 1.17) or the NHS with the option of referral to onsite clinicians (0.94, 95% CI 0.85 to 1.05) following the introduction to make triage decisions. To promote ease of of NHS 111. access, the telephone number is easy to Conclusions: A new telephone triage service did not remember, and the service is available at all improve perceptions of urgent care or the health times. service. This could be explained by the small amount Policymakers introduced the new service to of NHS 111 activity in a large emergency and urgent improve access to urgent care, increase effi- care system. ciency by directing people to the right place ScHARR, University of first time, increase satisfaction with urgent Sheffield, Sheffield, UK care and the National Health Service (NHS) Correspondence to INTRODUCTION generally, and in the longer term reduce Professor A O’Cathain; Telephone triage plays a significant role in unnecessary calls to the emergency ambu- – [email protected] the delivery of healthcare internationally.1 6 lance service.7 England had a pre-existing Knowles E, et al. BMJ Open 2016;6:e011846. doi:10.1136/bmjopen-2016-011846 1 Downloaded from http://bmjopen.bmj.com/ on November 2, 2016 - Published by group.bmj.com Open Access nationally available nurse-led 24-hour telephone help- Sampling line called NHS Direct which also provided out of hours Survey methodology which had been previously tested and call handling for some general practices. NHS 111 was validated was used.12 Amarketresearchcompanywas introduced to eventually replace this national telephone engaged to undertake a telephone survey of the general service, and this finally occurred across England in 2014. population in each NHS 111 and control area before NHS Policymakers intended that NHS 111 be an improve- 111 was launched and exactly 12 months later. The age ment over NHS Direct by offering easier and quicker and sex profile of each area population formed the sam- access to health advice for urgent healthcare through an pling frame for quota sampling. The market research easier to remember number, shorter assessment times company undertook random digit dialling with 1 attempt and shorter waiting times because most callers would to contact a landline telephone number, aiming to identify receive advice from a non-clinical operator rather than 2000 respondents in each of the 7 areas in each year, rep- waiting for advice from a nurse. resentative of the age/sex profile of the population. NHS 111 started in four areas in 2010, with roll out Standard market research procedures were followed to occurring in different areas over subsequent years. identify an adult to speak to within a household who was Evaluation of NHS 111 in the first 4 areas showed that aged 16 and over. An adult or a child in the household was although it was generally acceptable to users,8 over half selected as the focus of the interview in line with meeting the population were aware of it and 1 in 10 had called it the quota sample. The surveys were undertaken in 2010, at some point in the 9 months postlaunch,9 it did not ∼1 month prior to the planned launch of NHS 111 in have the expected effect of reducing use of emergency each area and again in 2011. services by directing callers to urgent care services, A sample size of 2000 in each area in each time period general practice and self-care.10 Indeed, it increased the was chosen based on previous use of the questionnaire to use of emergency ambulance services by a small amount. identify recent users of the urgent care system.13 We esti- As part of a larger evaluation of NHS 111 in the first four mated that 15% of respondents would be recent users, areas,11 we undertook a controlled before and after giving us 1200 urgent care users in the NHS 111 areas population survey to measure its effect on perceptions of each year and 900 in the control areas. A key outcome is urgent care provision and the health service generally. overall satisfaction with recent use of the urgent care system. Our previous survey identified 39% of urgent care users reporting their recent use as ‘excellent’.14 Asample METHODS size of 1065 in each time period would give us 80% power Design to detect a difference of 6 percentage points at the 5% We undertook a controlled before and after population level before and after the introduction of NHS 111. survey in each of the four NHS 111 areas, and three control areas, prior to the launch of NHS 111 and exactly Questionnaire fi 12 months later. The population survey identi ed recent The validated Urgent Care System Questionnaire admi- users of urgent care and sought their views about their nistered in the survey was developed based on qualitative most recent episode of care, as well as identifying popula- research with users of the emergency and urgent care tion satisfaction with urgent care and with the NHS.
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