Wednesday, November 07, 2012

It Seems Providing Urgent Healthcare Advice Phone Numbers Is Not All That Useful. The Benefits Are Hard To Find.

The following appeared a little while ago.

NHS 111 fails to deliver benefits

29 October 2012   Rebecca Todd
NHS 111 has not improved efficiency in the NHS and has a low probability of cost savings to the emergency and urgent care system, an independent evaluation report says.
However, a “simplistic economic analysis” concludes that national roll-out of the urgent care telephone number "could potentially" save the NHS money.
NHS 111 has dealt with more than 1m calls since its introduction in August 2010 and is live in 13 sites across England.
The University of Sheffield has published its ‘Evaluation of NHS 111 pilot sites’ report into the first four sites to go live.
It concludes that one year after launch, the pilots had “not delivered the expected benefits in terms of improving satisfaction with urgent care or improving efficiency by directing patients to urgent rather than emergency care services.”
There was no significant change in emergency ambulance calls, A&E attendances or urgent care attendances.
But there was an increase in ambulance call-outs of 29 additional incidents per 1,000 NHS 111 triaged calls per month. Researchers say this trend should be investigated.
The British Medical Association has expressed concern about the potential for NHS 111 to drive up demand for health services.
Various groups have also expressed disquiet about the government pushing ahead with a national roll-out of the service before the independent evaluation report had been released.
The report’s economic analysis for all sites estimated that NHS 111 would cost an extra £307,000 per month in these sites and that this might vary between saving £118,000 and costing £733,000.
A simplistic economic analysis of the likely effects of the national roll-out of the service – including replacing NHS Direct and the impact on GP out-of-hours call handling - said that it could potentially save the NHS money.
“Assuming 7.8m NHS 111 calls per year, the estimated monthly cost impact to the NHS would be a saving of £2.5m, although this could vary between a saving of £12million and an additional cost of £7m,” the report says.
More here:
This service seems to be rather similar to what we have had here for the last little while.

24 hour health advice line

1800 022 222
healthdirect Australia is a FREE* 24-hour telephone health advice line staffed by Registered Nurses to provide expert health advice.

We all feel better when we know what to do.

That’s the idea behind healthdirect Australia’s health advice line: fast and simple expert advice about any health issue and what to do next. Every time you call healthdirect you’ll talk directly with a Registered Nurse. We provide a 24-hour service you can use any time you are anxious about any health issue. We can also help with general health information and direct you to local health services. Call 1800 022 222
The 24-hour telephone health advice line is currently available to residents of the Australian Capital Territory, New South Wales, the Northern Territory, Tasmania, South Australia and Western Australia. 
Here is the website
What is also interesting is that evaluations are hard to find - even after a decade of operation.
The following .pdf from Professor David Dunt and Ms Rosemary McKenzie of the Centre for Health Policy Programs and Economics  Dated March 2012 provided a few clues on such services:
Literature review, looking at national and international literature and policies
–Fifty seven papers and reports reviewed, many from the UK based on experience of NHS direct
–Much of the literature considered telephone triage using guideline-based, decision-support software as an entry point to integrated out of hours care
–Few very clear findings on safety, effectiveness, broader demand implications and cost effectiveness
Main conclusions of literature review,
–A positive impact on GPs’ satisfaction, even if limited in some studies
–A limited impact on the satisfaction of the patients. in particular for triage and telephone consultations. Waiting times and accessibility are topics of possible dissatisfaction
–A limited impact on health system efficiency. The exception is a positive impact on GP workload for cooperatives with triage and telephone advices
–Lack of studies on the impact on clinical outcomes; in particular no studies comparing the quality of care between models (KCE, 2012)
The full presentation is found here:
This local evaluation I found was slightly encouraging:
All in all if this works and makes a difference it is odd that positive reports are not published and easy to find - or is this an evidence free initiative like good old NEHRS.
Links to formal evaluations please in the comments on this blog so we can all know.
David.
Post Script Monday 5/11/2012.
After writing this blog on the weekend guess what we have the next day? An Australian paper in the MJA published today which says much the same as I was suggesting above:
Here are 2 links:
First we have.

Help line no help to A&E costs

5/1/2012
Emma Connors
Patients who refuse to heed medical advice from after-hours help lines have cast doubt on whether the telephone services prevent unnecessary visits to emergency departments.
Research conducted over nine months at the Royal Perth Hospital shows just over half of those who went to the emergency department after speaking to a nurse on the healthdirect help line were advised not to go to hospital.
The finding has prompted the doctors who carried out the study and the Rural Doctors Association to question the cost-effectiveness of taxpayer- funded help lines.
However, the government and the Consumers Health Forum say the research is irrelevant. The findings are published in the November edition of the Medical Journal of Australia but are based on data collected more than three years ago.
The survey was taken before the Rudd government announced it would plough $126.3 million into extending healthdirect into a national service where nurses could refer calls to a doctor.
“It is disappointing that conclusions have been drawn from the study when data collection ceased in April 2009, before the after-hours GP helpline was established,” said a spokesman for Health Minister Tanya Plibersek.
Lots more here:
Also here:

New doubts about helpline

A WEST Australian study has cast fresh doubt over the ability of telephone consultation and triage lines to reduce demand in emergency departments.
Researchers found 52.4% of patients who attended Royal Perth Hospital’s ED after contacting the healthdirect Australia phone helpline did so even after being advised not to, according to the research published in the latest MJA. (1)
The researchers also compared the number of attendees who made their own decision to go to the ED against those who were advised to by healthdirect and found both groups were equally likely to get it right.
healthdirect referrals and self-referrals were assessed as similar in “appropriateness” at 72.9% and 73.8% respectively, according to the researchers, while GP referrals scored the highest level of appropriateness at 89.7%.
The findings have raised questions over whether healthdirect represents a good use of scarce health funding.
Lots more here:
Despite all this - we still need a proper current evaluation!
D.

1 comment:

Anonymous said...

The medical profession are under attack for not practicing "evidence based medicine" while the government spends billions of projects where the evidence is either absent, or suggests they are doing the wrong thing. The PCEHR was destined for failure, as was most of Nehtas work, so it must really make some hollow men feel really important when they can spend billions despite this.