Objective: To examine the outcomes of calls to NHS Direct (NHS-D) in relation to attendance at the accident and emergency (A&E) department. Design: A prospective collection of data about consecutive calls to NHS-D North West Coast was matched with attendances at the A&E department over a period of 3 months. Setting: NHS-D Regional Trust and a large urban paediatric A&E department. Patients: Children and young adults aged ,16 years living in local postal code areas. Main outcome measures: To examine (1) whether advice given by NHS-D was followed and (2) the differences in disease severity and necessity of attendance of patients referred by NHS-D and those referred by general practitioners and self-presenters. Results: The relationship between the advice given and subsequent action is complex. Only 70% of calls advised to attend the A&E department did so. A further 1% (176) were advised not to attend the A&E department did in fact attend the department. Patients referred by NHS-D represented only 3.2% of department attendances. There was little difference in the triage categories of the presenting groups, but there were significantly less admissions (p,0.01) in the NHS-D group. Conclusions: Delivering telephone advice about illness severity in children is difficult as visual clues are so important. More collaborative prospective studies are needed, including with primary care, to understand families' choices, and to refine and assess NHS-D's ability to discriminate those requiring further clinical assessment.
The aim of this study was to determine the level of usage of National Health Service Direct (NHSD) by ethnic and gender groups within an urban population. The study population comprised all individuals in the City of Preston, Lancashire, United Kingdom, who had used NHS Direct between 01 July 2003 and 31 December 2003. The ethnic and gender composition of this population was compared with that of the total population within the study area. The United Kingdom census information was analyzed to determine the ethnic composition of the total population studied. The expected and actual usage of NHS Direct was determined for each section of the population and compared by means of Chi-square analysis and the use of standardized residuals. Females from the white ethnic group used the service more than expected, whereas females from all ethnic groups combined used the service less than predicted. For male callers, Black-African, Indian, Pakistani, Bangladeshi, and Asian groups used the service more than expected. Particularly high usage was observed in Indian and Pakistani groups. The findings of this study show that NHS Direct is being under-used by certain ethnic groups and a difference in usage exists depending on gender. As the NHSD is intended to be the first port-of-call for healthcare advice, determining why certain groups use the service more than others is important. Census data show that the ethnic minority communities have grown significantly in recent years. Information is lacking, however, on the differences in the usage of healthcare services by different ethnic components of the population. A consequence of this situation is that certain decisions relating to health care policy cannot be targeted effectively. This limitation is important as the Race Relations (Amendment) Act 2000 places a statutory duty on NHS organizations to promote race equality, in policy and service delivery. Our findings also raise questions relating to the reliability of some current forms of disease surveillance and also show that NHS Direct data to determine patterns of disease, within the population, will be biased by the uneven usage of the service.
Objectives: To assess the acceptability to patients attending accident and emergency (A&E) of routine questioning about violence. Methods: A questionnaire survey (15 questions; 5 point Likert scale) was distributed to a representative sample of all adult patients attending a district general hospital A&E department, Lancashire, England over a seven day period. Results: 303 questionnaires were distributed and 281 returned questionnaires were available for analysis. Some 67% (95%CI 60% to 74%) of patients agreed that people attending A&E should routinely be asked about whether they have been assaulted. Altogether 89% (95%CI 85% to 93%) thought that health care staff should encourage victims of abuse or violence to inform the police, while 74% (95%CI 68% to 80%) thought that health care staff should routinely inform the police. While only 45% (95%CI 36% to 54%) of patients thought that people who had been assaulted would be likely to tell if asked, 81% (95%CI 76% to 86%) thought that if they themselves were victims they would tell if asked directly. Conclusions: Patients attending A&E departments support routine questioning by doctors and nurses about violence. They also support health professionals routinely informing the police in cases of violence. Further research is required into the outcomes of routine and direct questioning in A&E of patients about their exposure to violence. V iolence is increasingly recognised as an important health care issue. Attendance at accident and emergency (A&E) departments following violent incidents is increasing, 1 as is the level of violence among young men. 2The NHS has an important role in local violence prevention, 3 with a requirement for the collection of health services data on victims of violence.But while the health service provides care to large numbers of patients injured as a result of violence, there is currently no national system of violence surveillance in A&E departments.1 However, local initiatives, such as those in South Wales, where information on injuries is used for informing violence prevention strategies, have been developed. 5Identification of the victims of violence also allows the targeting of effective interventions but it is generally agreed that there is inadequate recognition of victims of violence.6 Interest has focused on routine questioning of patients for violence, although this has largely been restricted to domestic violence.7 While the American Medical Association recommends routine screening of women for domestic violence, 8 the British Medical Association does not recommend such an approach. 9Clearly any process of identification must be acceptable to patients. A USA study found that the majority of patients would welcome inquiries about violent assault, 10 and a UK study in primary care indicated that the majority of patients would tell their GP if asked directly about violence.11 However, no previous study has attempted to assess the attitudes of patients attending A&E departments in the UK.The aim of this study was to determine the acce...
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