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

2021 ◽  
Vol 9 (21) ◽  
pp. 1-148
Author(s):  
Janette Turner ◽  
Emma Knowles ◽  
Rebecca Simpson ◽  
Fiona Sampson ◽  
Simon Dixon ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Services ◽  
Smartphone Application ◽  
Urgent Care ◽  
Telephone Service ◽  
Online Service ◽  
Implementation Phase ◽  
Qualitative Interview Study ◽  
The Impact ◽  
Care System

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.

scholarly journals Understanding and evaluating new models of Child and Adolescent Mental Health Services in South-East England: a study protocol for an observational mixed-methods study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e024230 ◽  
Author(s):  
Stephen Rocks ◽  
Melissa Stepney ◽  
Margaret Glogowska ◽  
Mina Fazel ◽  
Apostolos Tsiachristas
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Mental Health Services ◽  
Health Services ◽  
Health Outcomes ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Resource Utilisation ◽  
South East England ◽  
The Impact

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a requirement to transform services to improve accessibility, quality of care and health outcomes. Following the submission of government-mandated transformation plans for CAMHS, services in England are changing in how, where and by whom they are delivered. This protocol describes the research methods to be applied to understand CAMHS transformations and evaluate the impact on the use of mental health services, patient care, satisfaction, health outcomes and health resource utilisation costs.Methods and analysisA mixed-methods approach will be taken in an observational retrospective study of CAMHS provided by a large National Health Service (NHS) mental health trust in South-East England (Oxford Health NHS Foundation Trust). Quantitative research will include descriptive analysis of routinely collected data, with difference-in-differences analysis supplemented with propensity score matching performed to assess the impact of CAMHS transformations from 2015 onwards. An economic evaluation will be conducted from a healthcare perspective to provide commissioners with indications of value for money. Qualitative research will include observations of services and interviews with key stakeholders including CAMHS staff, service users and guardians, to help identify mechanisms leading to changes in service delivery, as well as barriers and enabling factors in this phase of transformation.Ethics and disseminationThis project has been registered with NHS Oxford Health Foundation Trust as a service evaluation. Informed consent will be sought from all stakeholders partaking in interviews according to good clinical practice. A local data sharing protocol will govern the transfer of quantitative data. Study findings will be published in professional journals for NHS managers and peer-reviewed scientific journals. They will be discussed in seminars targeting CAMHS providers, managers and commissioners and presented at scientific conferences.

scholarly journals Assessing the perceived impact of post Minamata amalgam phase down on oral health inequalities: a mixed-methods investigation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
V. R. Aggarwal ◽  
S. Pavitt ◽  
J. Wu ◽  
B. Nattress ◽  
P. Franklin ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Health Inequalities ◽  
Dental Amalgam ◽  
Free Text ◽  
Oral Health Services ◽  
Phase Out ◽  
The Impact

Abstract Background Data from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services. Methods A mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities. Results Time-trends for amalgam placement showed that there was a significant (p < 0.05) reduction in amalgam use compared with composites and glass ionomers. However dental amalgam still represented a large proportion (42%) of the restorations (circa 1.8 million) placed in the 2016–2017 financial year. Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations. Conclusion Amalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.

scholarly journals Establishing and implementing best practice to reduce unplanned admissions in those aged 85 years and over through system change [Establishing System Change for Admissions of People 85+ (ESCAPE 85+)]: a mixed-methods case study approach

2015 ◽  
Vol 3 (37) ◽  
pp. 1-202 ◽  
Author(s):  
Andrew Wilson ◽  
Richard Baker ◽  
John Bankart ◽  
Jay Banerjee ◽  
Ran Bhamra ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Health Services ◽  
Older People ◽  
Emergency Departments ◽  
System Change ◽  
System Level ◽  
Striking Difference ◽  
Admission Rates ◽  
The Impact

BackgroundIn England, between 2007/8 and 2009/10, the rate of unplanned hospital admissions of people aged 85 years and above rose from 48 to 52 per 100. There was substantial variation, with some areas showing a much faster rate of increase and others showing a decline.ObjectivesTo identify system characteristics associated with higher and lower increases in unplanned admission rates in those aged 85 years and over; to develop recommendations to inform providers and commissioners; and to investigate the challenges of starting to implement these recommendations.DesignMixed-methods study using routinely collected data, in-depth interviews and focus groups. Data were analysed using the framework approach, with themes following McKinsey’s 7S model. Recommendations derived from our findings were refined and prioritised through respondent validation and consultation with the project steering group. The process of beginning to implement these recommendations was examined in one ‘implementation site’.ParticipantsSix study sites were selected based on admission data for patients aged 85 years and above from primary care trusts: three where rates of increase were among the most rapid and three where they had slowed down or declined. Each ‘improving’ or ‘deteriorating’ site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services, and adult social care. At each site, representatives from these organisations at strategic and operational levels, as well as representatives of patient groups, were interviewed to understand how policies had been developed and implemented. A total of 142 respondents were interviewed.ResultsBetween 2007/8 and 2009/10, average admission rates for people aged 85 years and over rose by 5.5% annually in deteriorating sites and fell by 1% annually in improving sites. During the period under examination, the population aged 85 years and over in deteriorating sites increased by 3.4%, compared with 1.3% in improving sites. In deteriorating sites, there were problems with general practitioner access, pressures on emergency departments and a lack of community-based alternatives to admission. However, the most striking difference between improving and deteriorating sites was not the presence or absence of specific services, but the extent to which integration within and between types of service had been achieved. There were also overwhelming differences in leadership, culture and strategic development at the system level. The final list of recommendations emphasises the importance of issues such as maximising integration of services, strategic leadership and adopting a system-wide approach to reconfiguration.ConclusionsRising admission rates for older people were seen in places where several parts of the system were under strain. Places which had stemmed the rising tide of admissions had done so through strong, stable leadership, a shared vision and strategy, and common values across the system.Future workResearch on individual components of care for older people needs to take account of their impact on the system as a whole. Areas where more evidence is needed include the impact of improving access and continuity in primary care, the optimal capacity for intermediate care and how the frail elderly can best be managed in emergency departments.Study registrationUK Clinical Reasearch Network 12960.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study (Preprint)

2019 ◽  
Author(s):  
Arne Hansen ◽  
Maximilian Herrmann ◽  
Jan P Ehlers ◽  
Thomas Mondritzki ◽  
Kai Oliver Hensel ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care System ◽  
Delphi Method ◽  
Machine Learning Algorithms ◽  
Mixed Methods Study ◽  
Health Care Market ◽  
German Health ◽  
The Impact ◽  
Care System

BACKGROUND Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. OBJECTIVE We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. METHODS This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. RESULTS There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses “H8: Digitization in the health care system will free up jobs,” and “H6: Digitization in the health care system will empower the patients,” perceived to be in profound disagreement (<italic>P</italic>=.036 and <italic>P</italic>&lt;.001, respectively). CONCLUSIONS Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree.

scholarly journals Perception of the Progressing Digitization and Transformation of the German Health Care System Among Experts and the Public: Mixed Methods Study

10.2196/14689 ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. e14689 ◽  
Author(s):  
Arne Hansen ◽  
Maximilian Herrmann ◽  
Jan P Ehlers ◽  
Thomas Mondritzki ◽  
Kai Oliver Hensel ◽  
...  
Keyword(s):  
Health Care ◽  
Mixed Methods ◽  
Health Care System ◽  
Delphi Method ◽  
Machine Learning Algorithms ◽  
Mixed Methods Study ◽  
Health Care Market ◽  
German Health ◽  
The Impact ◽  
Care System

Background Health care systems worldwide are struggling to keep rising costs at bay with only modest outcome improvement among many diseases. Digitization with technologies like Artificial Intelligence or Machine Learning algorithms might address this. Although digital technologies have been successfully applied in clinical studies the effect on the overall health care system so far was limited. The regulatory ecosystem or data privacy might be responsible, but other reasons may also predominate. Objective We analyzed how the digitization of the German health care market is currently perceived among different stakeholders and investigated reasons for its slow adaption. Methods This was a mixed methods study split into a qualitative Part A using the conceptual approach of the Grounded Theory and a quantitative Part B using the Delphi method. For Part A we interviewed experts in the health care system and converted the results into 17 hypotheses. The Delphi method consisted of an online survey which was sent to the participants via email and was available for three months. For the assessment of the 17 hypotheses, the participants were given a six-point Likert scale. The participants were grouped into patients, physicians, and providers of services within the German health care market. Results There was a strong alignment of opinions on the hypotheses between experts (N=21) and survey participants (N=733), with 70.5% overall agreement on 12/17 hypotheses. Physicians demonstrated the lowest level of agreement with the expert panel at 88% (15/17) disagreement, with the hypotheses “H8: Digitization in the health care system will free up jobs,” and “H6: Digitization in the health care system will empower the patients,” perceived to be in profound disagreement (P=.036 and P<.001, respectively). Conclusions Despite the firm agreement among participants and experts regarding the impact of digitization on the health care system, physicians demonstrated a more negative attitude. We assume that this might be a factor contributing to the slow adoption of digitization in practice. Physicians might be struggling with changing power structures, so future measures to transform the market should involve them to a larger degree.

scholarly journals AMORE Project: Integrated knowledge translation and geospatial analysis to improve travel times to health services (accessibility) and health equity in Cali, Colombia: a proof of concept using mixed-methods research

2021 ◽  
Author(s):  
Luis Gabriel CUERVO ◽  
Daniel Cuervo ◽  
Janet Hatcher-Roberts ◽  
Eliana Martínez Herrera ◽  
Luis Fernando Pinilla ◽  
...  
Keyword(s):  
Health Services ◽  
Traffic Congestion ◽  
Service Providers ◽  
Service Planning ◽  
Urgent Care ◽  
Research Assessment ◽  
Situational Analysis ◽  
Data Generation ◽  
Proof Of Concept ◽  
The Impact

Addressing accessibility to health services requires intersectoral multi-stakeholder action. There is not a lot of knowledge about the effects of traffic congestion on accessibility. The availability of new data allows putting forward simple metrics that all stakeholders can manage. This proof-of-concept reveals accessibility using a platform with intuitive heatmaps/choropleths, dials, and graphs. It uses filters and shows accessibility according to socio-demographic characteristics. It is dynamic, reflecting the impact of changes in traffic congestion. The platform (AMORE Platform) provides a situational analysis that can be updated as conditions or data changes. The Platform reveals and quantifies inequities of accessibility and allows maximizing accessibility by optimizing the location for new services. The proof-of-concept uses two scenarios (1) urgent care in a tertiary hospital; and (2) frequent care (hemodialysis and radiotherapy). The data generation component will be complemented with a participatory action research assessment with project collaborators involving different stakeholders (e.g., authorities, service providers and users, organized civil society and academia) who will use the platform and could determine its value and potential in service planning, urbanism, and intersectoral and multistakeholder collaboration. The platform can be updated and modified to cover other services within and beyond the health sector. The proof-of-concept is done in Cali, Colombia's third most populous city, with inputs from a broad range of stakeholders.

The impact of Aboriginal community controlled health service advocacy on Aboriginal health policy

2005 ◽  
Vol 11 (2) ◽  
pp. 53 ◽  
Author(s):  
Ben Bartlett ◽  
John Boffa
Keyword(s):  
Health Policy ◽  
Health Service ◽  
Health Services ◽  
Torres Strait Islander ◽  
Aboriginal Health ◽  
Aboriginal Community ◽  
Implementation Phase ◽  
Torres Strait ◽  
Strategic Relationships ◽  
The Impact

This paper reviews the advocacy role of Aboriginal community controlled health services (ACCHSs) in the development of Aboriginal health policy over the past 30 years, with a specific focus on the recent changes in Commonwealth funding and administrative responsibility - the transfer of Aboriginal health service funding from the Aboriginal and Torres Strait Islander Commission (ATSIC) to the Office of Aboriginal and Torres Strait Islander Health Services (OATSIHS) within the Commonwealth Department of Health and Ageing (DoHA), and the development of policies aimed at Aboriginal health services accessing mainstream (Medical Benefits Scheme [MBS]) funds. The outcomes of this policy change include a significant increase in funding to Aboriginal primary health care (PHC), the inclusion of ACCHSs in collaborative strategic relationships, and the development of new arrangements involving regional planning and access to per capita funds based on MBS equivalents. However, the community sector remains significantly disadvantaged in participating in this collaborative effort, and imposed bureaucratic processes have resulted in serious delays in releasing funds for actual services in communities. Government agencies need to take greater heed of community advocacy, and provide appropriate resourcing to enable community organisations to better direct government effort, especially at the implementation phase. These remain major concerns and should be considered by non-health sectors in the development of new funding and program development mechanisms in the wake of the abolition of ATSIC.

scholarly journals A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol

2021 ◽  
Vol 12 ◽  
Author(s):  
Rebecca Lane ◽  
Sophie D'Souza ◽  
Maria Livanou ◽  
Jenna Jacob ◽  
Wendy Riches ◽  
...  
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Realist Evaluation ◽  
Research Association ◽  
The Impact

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS).Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service.Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

scholarly journals How to govern the digital transformation of health services

2019 ◽  
Vol 29 (Supplement_3) ◽  
pp. 7-12 ◽  
Author(s):  
Walter Ricciardi ◽  
Pedro Pita Barros ◽  
Aleš Bourek ◽  
Werner Brouwer ◽  
Tim Kelsey ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health System ◽  
Health Care System ◽  
Digital Health ◽  
Digital Transformation ◽  
Broad Perspective ◽  
Health Technologies ◽  
The Impact ◽  
Care System

Abstract The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the ‘digital transformation’. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.

scholarly journals DISASTER-RESILIENT HOSPITALS: THE NOAH’S ARK

2016 ◽  
Vol 2 (4) ◽  
pp. 172-176
Author(s):  
Geetha Mani ◽  
Raja Danasekaran ◽  
Kalaivani Annadurai
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care System ◽  
Three Dimensional ◽  
Health Sector ◽  
Health Care Facilities ◽  
Economic Damage ◽  
The Impact ◽  
Care System

Health services are important lifelines of a community any time and this role is more pronounced during times of disasters. Evidence from various parts of the world presents examples of disaster-induced damage to hospitals and failure of health services at times of need. The impact of disasters-induced damage to health care is three-dimensional: health, social and economic. Damage to health care facilities apart from delaying and complicating relief measures also compromise the achievement of planned national and global health and related goals. The indirect and long-term costs of damage to health sector are greater than direct and immediate costs, compounding the disastrous consequences on the economy. The increasing invasion of nature spaces, climate change and urbanisation are bound to aggravate more natural hazards in future. So a resilient health care system is an immediate necessity for all global states. This paper discusses the international and national endeavours towards a resilient health-care system and analyses the strategies to promote safe hospitals in future.

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