Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods study

Background The NHS emergency and urgent care system is under pressure as demand for services increases each year. NHS 111 is a telephone triage service designed to provide advice and signposting to appropriate services for people with urgent health-care problems. A new service, NHS 111 Online, has been introduced across England as a digital alternative that can be accessed using a website or a smartphone application. The effects and usefulness of this service are unknown. Objectives To explore the impact of NHS 111 Online on the related telephone service and urgent care system activity and the experiences of people who use those services. Design and methods A mixed-methods design of five related work packages comprising an evidence review; a quantitative before-and-after time series analysis of changes in call activity (18/38 sites); a descriptive comparison of telephone and online services with qualitative survey (telephone, n = 795; online, n = 3728) and interview (32 participants) studies of service users; a qualitative interview study (16 participants) of staff; and a cost–consequences analysis. Results The online service had little impact on the number of triaged calls to the NHS 111 telephone service. For every 1000 online contacts, triaged telephone calls increased by 1.3% (1.013, 95% confidence interval 0.996 to 1.029; p = 0.127). Recommendations to attend emergency and urgent care services increased between 6.7% and 4.2%. NHS 111 Online users were less satisfied than users of the telephone service (50% vs. 71%; p < 0.001), and less likely to recommend to others (57% vs. 69%; p < 0.001) and to report full compliance with the advice given (67.5% vs. 88%; p < 0.001). Online users were less likely to report contacting emergency services and more likely to report not making any contact with a health service (31% vs. 16%; p < 0.001) within 7 days of contact. Thirty-five per cent of online users reported that they did not want to use the telephone service, whereas others preferred its convenience and speed. NHS 111 telephone staff reported no discernible increase or decrease in their workload during the first year of operation of NHS 111 Online. If online and telephone services operate in parallel, then the annual costs will be higher unless ≥ 38% of telephone contacts move to online contacts. Conclusions There is some evidence that the new service has the potential to create new demand. The service has expanded significantly, so it is important to find ways of promoting the right balance in numbers of people who use the online service instead of the telephone service if it is to be effective. There is a clear need and preference by some people for an online service. Better information about when to use this service and improvements to questioning may encourage more uptake. Limitations The lack of control arm means that impact could have been an effect of other factors. This work took place during the early implementation phase, so findings may change as the service expands. Future work Further development of the online triage process to make it more ‘user friendly’ and to enable users to trust the advice given online could improve use and increase satisfaction. Better understanding of the characteristics of the telephone and online populations could help identify who is most likely to benefit and could improve information about when to use the service. Trial registration Current Controlled Trials ISRCTN51801112. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 21. See the NIHR Journals Library website for further project information.

A broadband integrated time series (BITS) for longitudinal analyses of the digital divide

To evaluate actions taken to implement the Telecommunications Act of 1996, the primary goal of which was to foster competition in the industry, the FCC created a standardized form (Form 477) to collect information about broadband deployment and competition in local telephone service. These data represent the best publicly available record of broadband provision in the United States. Despite the potential benefits offered by this database, there are several nuances to these data related to shifting geographies and reporting requirements that uncorrected, prevent them from being used as an uninterrupted time series for longitudinal analyses. Given the analytical challenges associated with the FCC Form 477 data, the purpose of this paper is to present a solution to the fragmented nature of these data which prevents meaningful longitudinal analyses of the digital divide. Specifically, this paper develops and describes a procedure for producing an integrated broadband time series (BITS) for the last decade (2008–2018). This includes the procedures for using these data, their value to social and economic analysis, and their underlying limitations. The core contribution of this paper is the creation of data infrastructure for investigating the evolution of the digital divide.

96 Impact of COVID19 Restrictions on Older Patients Attending An Outpatient Service

Introduction During the Covid19 pandemic older adults (&gt;70 years) in Ireland were advised to stay at home and avoid unnecessary physical contact—termed “cocooning”. During this time hospital outpatient appointments were conducted virtually (via telephone). This project aimed to assess patients experience of Covid19 cocooning and the virtual outpatient service. Methods Patients attending an outpatient geriatric medicine service were invited to participate in this project following their routine virtual assessment. A proforma questionnaire was administered to participants contacted virtually within one week of consent. Data was anonymised, imported into excel and analysed using SPSS (chi-squared test). Results 31 patients were included, median age was 83 years. 52% were male, 25% lived alone and 52% had cognitive impairment. 77% had heard of “cocooning”, of which 79% correctly understood the term. Three-quarters stated that cocooning had negatively impacted their quality of life (QoL); anxiety, loneliness and depression were reported in 49%, 36% and 29% respectively. 39% strongly feared getting Covid19. Cognition and living status did not correlate significantly with the psychological impact of Covid19. 61% did not use modern social media, its use did not impact QoL scores (p = 0.075). 45% experienced a reduction in support services. 87% found the OPD telephone service useful and 77% reported their needs were addressed. Three-quarters favoured future virtual assessments. Conclusion One third of patients poorly understood “cocooning”. Necessary Covid19 restrictions impacted negatively psychologically on this older cohort. Novel virtual clinics proved a positive experience and a useful future outpatient resource even amongst our oldest patients with dementia.

Problemática psicosocial y de salud mental reportada por consultantes del servicio de atención telefónica Línea de la Vida, derivados a Centros de Integración Juvenil durante la epidemia de COVID-19

Introduction: in the context of the health contingency by COVID-19 pandemic and by an agreement of the Mexican Ministry of Health, Centros de Integración Juvenil has collaborated in Línea de la Vida telephone service conducted by the National Comission on Addictions in the care of people with mental health dissorders. Objective: to describe some aspects of the psychological and social problems associated with the epidemic, identifying intervening variables. Method: cross-sectional, comparative study, with a sample of 2,403 consultants from Línea de la Vida service, referred to CIJ between May and August 2020. Data included symptoms and risk conditions of COVID-19, mental health problems and daily circumstances during the epidemic. Comparative analysis were carried out by sex, age and date of consultation. Results: a third of the consultants reported symptoms of COVID-19, belonging to a vulnerable group or having contact with someone with the disease. The main mental health problems identified were anxiety/stress (67.6%) and depression (15.2%); 31.5% reported facing financial problems; 15.5% the loss of close people and around 10% having problems in the care of children, adolescents or other relatives; 5.6% reported domestic violence. Conclusions: the health, social, interpersonal and mental health problems associated with the COVID-19 pandemic reflect differences attributable to the social construction of gender, the life cycle of people and the development of the epidemic itself.

P531 A retrospective audit of the inflammatory bowel disease specialist nurse-led telephone advice service

Background Inflammatory bowel disease affects more than 300 000 people in the UK. The aims of the audit were to review the current use of a telephone service provided by the IBD specialist nursing team in a DGH with a view to better funding and further development of the facility. Methods The letters generated from each phone call between January and February 2018 were collected and a sample assessed for outcomes directly related to the consultation. Outcomes were subtyped into a change in medical treatment, referral for investigation, referral to another specialist or arrangement of an urgent clinic appointment or hospital admission. Each phone consultation was also assessed as to whether it had avoided an attendance to the GP or hospital via A&E or acute medicine. Results The two-month period yielded 491 phone calls, of which 100 letters were reviewed of which 56 (56%) had ulcerative colitis (UC), 44 (44%) had Crohn’s disease (CD). Male users comprised 36% (vs. 64% females) and the age of callers ranged from 19 to 84 years (median age 44 years). Of the UC patients, 45 patients (80.4%) had been diagnosed over 2 years previously with two (3.6%) having been diagnosed within the preceding 3 months (CD patients 34 (77.3%) &gt;2 years previously and three (6.8%) within the last 3 months). The phone consultations led to a change in medication in 49 cases (49%). Phlebotomy and/or faecal calprotectin testing was requested for 59 patients (59%) following the phone call and a further 17 (17%) were discussed with a consultant, although only 8 (8%) required an IBD nurse-led or gastroenterology consultant-led clinic (six and two patients, respectively). Nine patients (9%) went on to have cross-sectional imaging or ultrasound with contrast and 7 (7%) were referred for endoscopic assessment. The overall complexity of the consultation was assessed by the number of services referred to/requested. Thirty-four patients (34%) merely required reassurance or verbal advice whereas two cases (2%) led to five distinct referrals or investigation requests (one service 33 (33%), two service 20 (20%), three service 9 (9%), four service 3 (3%)). Each phone call was assessed as to whether it had likely avoided attendance elsewhere. This included general practice (25 cases (25%)), accident and emergency (2 (2%)), IBD nurse clinic appointment (41 (41%)) or consultant clinic appointment (6 (6%)). Conclusion (1) Our audit shows that the IBD nurse-led telephone service is extremely demanding, with a large volume of calls. (2) Remote management of patients could be facilitated by the telephone nurse-led hotline advice service leading to a reduction in healthcare costs, avoiding face-to-face consultations and managing patients as per their personalised needs.