NHS Direct 'impact' studies are confounded by poor awareness of the service in target communities
Editor - The recent study by Munro et al 1 found that NHS Direct had
no discernible effect on the use of emergency ambulances or accident &
emergency departments after the first year, leading to a suggestion that
this service may not prove cost effective. However this study is limited
by an assumption that the population studied had complete awareness of the
service. Indeed six months after the introduction of East Midlands NHS
Direct, we had anecdotal evidence to suggest that many patients attending
our accident & emergency department were unaware of the telephone-
advisory service.
Consequently we undertook a NHS Direct 'awareness' survey of 300
consecutive ambulatory patients (or their parents), who self-referred to
the accident & emergency department, and who had not contacted NHS
Direct. 266 (88%) questionnaires were completed with 166 (62%) patients
claiming to have had no previous awareness of NHS Direct. Furthermore of
the 100 patients who were aware of the service only 36% were aware of the
telephone charge whilst 51% of patients thought that calls were taken by
doctors. Only 8% of 'aware' patients however said they would distrust
advice given by a nurse, a finding that supports the study by O'Cathain et
al 2.
The survey also determined which sections of the community were unaware of
NHS Direct. Patients over 65 years of age (100%), patients from ethnic
minorities (70%), patients from predominantly less affluent post-codes
(78%), and young men (71%) were over-represented. The survey also
revealed that 90% of patients claim to have access to a telephone and that
21% of patients may have been potentially redirected away from our
department by NHS Direct.
In light of these findings it is our assertion that NHS Direct has failed
to market its existence to those members of the community who frequently
access urgent health care. Consequently the results of NHS Direct
'impact' studies to date are confounded by this oversight. Whether a
proper national publicity campaign can improve the impact of this
beleaguered service, remains to be seen.
1. Munro J, Nicholl J, O'Cathain A, Knowles E. Impact of NHS Direct
on demand for immediate care: observational study. BMJ 2000; 321:150-3
2. O'Cathain A, Munro J, Nicholl J, Knowles E. How helpful is NHS
Direct? Postal survey of callers. BMJ 2000; 320:1035
John McInerney Specialist Registrar
Shekhar Chillala Specialist Registrar
Colin Read Specialist Registrar
Adrian Evans Consultant
Accident & Emergency department, The Leicester Royal Infirmary,
Leicester LE1 5WW
Rapid Response:
NHS Direct 'impact' studies are confounded by poor awareness of the service in target communities
Editor - The recent study by Munro et al 1 found that NHS Direct had
no discernible effect on the use of emergency ambulances or accident &
emergency departments after the first year, leading to a suggestion that
this service may not prove cost effective. However this study is limited
by an assumption that the population studied had complete awareness of the
service. Indeed six months after the introduction of East Midlands NHS
Direct, we had anecdotal evidence to suggest that many patients attending
our accident & emergency department were unaware of the telephone-
advisory service.
Consequently we undertook a NHS Direct 'awareness' survey of 300
consecutive ambulatory patients (or their parents), who self-referred to
the accident & emergency department, and who had not contacted NHS
Direct. 266 (88%) questionnaires were completed with 166 (62%) patients
claiming to have had no previous awareness of NHS Direct. Furthermore of
the 100 patients who were aware of the service only 36% were aware of the
telephone charge whilst 51% of patients thought that calls were taken by
doctors. Only 8% of 'aware' patients however said they would distrust
advice given by a nurse, a finding that supports the study by O'Cathain et
al 2.
The survey also determined which sections of the community were unaware of
NHS Direct. Patients over 65 years of age (100%), patients from ethnic
minorities (70%), patients from predominantly less affluent post-codes
(78%), and young men (71%) were over-represented. The survey also
revealed that 90% of patients claim to have access to a telephone and that
21% of patients may have been potentially redirected away from our
department by NHS Direct.
In light of these findings it is our assertion that NHS Direct has failed
to market its existence to those members of the community who frequently
access urgent health care. Consequently the results of NHS Direct
'impact' studies to date are confounded by this oversight. Whether a
proper national publicity campaign can improve the impact of this
beleaguered service, remains to be seen.
1. Munro J, Nicholl J, O'Cathain A, Knowles E. Impact of NHS Direct
on demand for immediate care: observational study. BMJ 2000; 321:150-3
2. O'Cathain A, Munro J, Nicholl J, Knowles E. How helpful is NHS
Direct? Postal survey of callers. BMJ 2000; 320:1035
John McInerney
Specialist Registrar
Shekhar Chillala
Specialist Registrar
Colin Read
Specialist Registrar
Adrian Evans
Consultant
Accident & Emergency department, The Leicester Royal Infirmary,
Leicester LE1 5WW
Competing interests: No competing interests