Dataset Information

Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017.

ABSTRACT: OBJECTIVES:To measure the frequency of patients making avoidable emergency department (ED) attendances after contact with NHS 111 and to examine whether these attendances can be predicted reliably. DESIGN:Analysis of 16?563?946 calls made to 111, where each call was linked with a record of whether the patient attended ED within 24?hours. SETTING:All regions of England from March 2015 to October 2017. PARTICIPANTS AND DATA:Our main regression model used a sample of 10?954?783 calls, each with detailed patient-level information. MAIN OUTCOME:Whether patients made an unadvised, non-urgent type 1 ED ('avoidable') attendance within 24?hours of calling 111. RESULTS:Of 16?563?946 calls to 111, 12?894?561 (77.8%) were not advised to go to ED (ie, they were advised to either attend primary care, attend another non-ED healthcare service or to self-care). Of the calls where the patient was not advised to go to the ED, 691?783 (5.4%) resulted in the patient making an avoidable ED attendance within 24?hours. Among other factors, calls were less likely to result in these attendances when they received clinical input (adjusted OR 0.52, 95%?CI 0.51 to 0.53) but were more likely when the patient was female (OR 1.07, 95%?CI 1.06 to 1.08) or aged 0-4 years (OR 1.34, 95%?CI 1.33 to 1.35). CONCLUSIONS:For every 20 calls where 111 did not advise people to attend the ED, 1 resulted in avoidable ED attendance within 24?hours. These avoidable attendances could be predicted, to a certain extent, based on call characteristics. It may be possible to use this information to help 111 call handlers identify which callers are at higher risk of these attendances.

SUBMITTER: Egan M

PROVIDER: S-EPMC7066618 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017.

Egan Mark M Murar Filip F Lawrence James J Burd Hannah H

BMJ open 20200309 3

<h4>Objectives</h4>To measure the frequency of patients making avoidable emergency department (ED) attendances after contact with NHS 111 and to examine whether these attendances can be predicted reliably.<h4>Design</h4>Analysis of 16 563 946 calls made to 111, where each call was linked with a record of whether the patient attended ED within 24 hours.<h4>Setting</h4>All regions of England from March 2015 to October 2017.<h4>Participants and data</h4>Our main regression model used a sample of 10 ...[more]

PMID: 32152158

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Project description:BackgroundUse of emergency department (ED) care globally seems to be increasing at a faster rate than population growth (Baker, House of Commons Library. Accident and Emergency Statistics, Demand, Performance, 2017). In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment (NHS Digital, Hospital Accident and Emergency Activity 2016-17, 2019) is cited as evidence that these patients did not require this level of care. The solution to not using the most appropriate point in the system has traditionally been seen as a knowledge problem, requiring, improved sign-posting and information to enable people to self-manage or use health care management for minor ailments. However research about help-seeking behaviour suggests that the problem may not be an informational one. A considerable literature points to help seeking as a social process influenced by a range of contingencies and contextual factors including the way in which lay people influence health care utilisation (Giebel et al. BMJ Open 9:1, 2019). Personal communities comprise a variety of active and significant social ties which have potential to influence individual capacity to seek help. Here we extend and unpack further influencing decisions about seeking formal health care with reference to how they are shaped and informed by and within personal social networks.MethodsWe undertook a personal network mapping and qualitative interview-based study to look at, problematize and understand attendance for non-urgent problems. We used network analysis and methods to map and characterise the personal communities of people seeking help from ED for minor ailments and semi-structured interviews with 40 people attending a single ED and associated GP hub providing equivalent care. Interviews were built around an ego network mapping activity and a topic guide structured to explore attender's narratives about why they had visited the ED. This ego network activity uses a diagram consisting of three concentric circles (Fiori et al. J Gerontol B-Psychol 62: 322-30, 2007), representing closest social network members (in the centre) and those at further distance. Participants were initially presented with one of these diagrams and asked to write names of people or resources that had played a role in their attendance and the interviewer probed the interviewee to discuss the actions, input and value of the people and services that supported the visit to the ED.ResultsWe analysed number and type of network connections and undertook a thematic analysis to identify how imagined and actual network members and influences were implicated in ED attendance. The network maps created during the interviews were examined and a typology of networks was developed and used to distinguish different types of networks informed by our reading of the data, and a Network Typology Scoring Tool, a measure of frequency of contact and relationship type in networks.ConclusionsOur study suggests that faced with acute minor illness or injury people's networks narrow: they do not (and perhaps cannot) mobilise their imagined care network because the resources or connections may not be there or are difficult to engage. In addition we identified important system drivers of behaviour, notably that these patients are often directed to the ED by 'professional influencers' including health services staff.

Project description:ObjectivesTo describe the uptake and outputs of the National Health Service Health Check (NHSHC) programme in England.DesignObservational study.SettingNational primary care data extracted directly by NHS Digital from 90% of general practices (GP) in England.ParticipantsIndividuals aged 40-74 years, invited to or completing a NHSHC between 2012 and 2017, defined using primary care Read codes.InterventionThe NHSHC, a structured assessment of non-communicable disease risk factors and 10-year cardiovascular disease (CVD) risk, with recommendations for behavioural change support and therapeutic interventions.ResultsDuring the 5-year cycle, 9 694 979 individuals were offered an NHSHC and 5 102 758 (52.6%) took up the offer. There was geographical variation in uptake between local authorities across England ranging from 25.1% to 84.7%. Invitation methods changed over time to incorporate greater digitalisation, opportunistic delivery and delivery by third-party providers.The population offered an NHSHC resembled the English population in ethnicity and deprivation characteristics. Attendees were more likely to be older and women, but were similar in terms of ethnicity and deprivation, compared with non-attendees. Among attendees, risk factor prevalence reflected population survey estimates for England. Where a CVD risk score was documented, 25.9% had a 10-year CVD risk ≥10%, of which 20.3% were prescribed a statin. Advice, information and referrals were coded as delivered to over 2.5 million individuals identified to have risk factors.ConclusionThis national analysis of the NHSHC programme, using primary care data from over 9.5 million individuals offered a check, reveals an uptake rate of over 50% and no significant evidence of inequity by ethnicity or deprivation. To maximise the anticipated value of the NHSHC, we suggest continued action is needed to invite more eligible people for a check, reduce geographical variation in uptake, prioritise engagement with non-attendees and promote greater use of evidence-based interventions especially where risk is identified.

Dataset Information

Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017.

Publications

Identifying the predictors of avoidable emergency department attendance after contact with the NHS 111 phone service: analysis of 16.6 million calls to 111 in England in 2015-2017.

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