Distribution of targeted educational materials to families after they attend emergency or urgent care services with a child under 5 years-old in a non-urgent situation, in order to reduce future repeat non-urgent attendances

Holden, Ben

doi:10.1186/isrctn74381956

Cited by 1 publication

(10 citation statements)

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“…The reported rationale for many interventions, whether delivered in primary or emergency care, was to reduce emergency care use for non-urgent complaints, including directing patients to primary care, 83,[85][86][87][88][89][90][91][92][93][94][95] and to reduce any and all health service use. [96][97][98] Some interventions were specifically designed to reduce reconsultation for a similar minor health problem, especially in primary care, [99][100][101] and, in some cases, the interventions sought to modify patients' and carers' consultation behaviour related to specific minor problems, such as childhood fever, 102,103 respiratory tract infections 84 and cough.…”

Section: Rationale For the Interventionmentioning

confidence: 99%

“…79,80,120,121,127,128 In some cases, the interventions were delivered by the researchers only. 83,85,89,94,110,134 Some interventions were delivered face to face to target groups of patients or carers at pre-set time points, in particular regular monitoring visits for babies and infants (e.g. Well Child Visits).…”

Section: Rationale For the Interventionmentioning

confidence: 99%

“…Such interventions were delivered principally at the time of the index consultation, [75][76][77][78]83,85,94,95,[99][100][101][102][103]109,130,131,136 but could also be delivered a little time later. 88,89,92,108,112,137 Another large group of interventions, principally in the community group, were delivered to people for consideration in the home setting. This might consist of written materials or information resources (e.g.…”

Section: Rationale For the Interventionmentioning

confidence: 99%

“…53,79,80,117,122,124,125,129,139,140 Tailoring/personalisation Many interventions do not appear to have involved any element of personalisation for the intended audience, carer or patient. When personalisation was undertaken, it most often involved one of the following approaches: most frequently, an interactive discussion between staff and the patient or carer concerning the content of the intervention (a leaflet, video, written material or workshop); 85,99,102,103,108,112,115,120,128,130,136 individual case management or patient navigation services; 87,91,93 the use of personalised data in automated systems; 89,98,111,123 directing patients specifically to their own local services; 94 and the use of the most appropriate language to communicate with patients and carers, for example English or Spanish. 95,125,126…”

Section: Rationale For the Interventionmentioning

confidence: 99%

“…99 No adverse events were associated with the intervention in a RCT of an educational booklet in EDs. 89 Sometimes the intervention group was followed up, and again no problems were identified: a 3-year medical record review of children in the intervention group showed no evidence of serious problems that might be associated with delaying seeking treatment; 135 there was no delay in seeking help for a cough that lasted more than3 weeks 78 and a reduction in GP consultations for non-serious coughs was accompanied by an increase in consultations for coughs with alarming symptoms. 77 Other measures of safety included premature death (there was no sign of a link between premature death at 6 months and the interventions 91 ) and breaking the rules of engaging with the intervention (there was some violation of rules, but not enough for the authors to be worried about 139 ).…”

Section: Safetymentioning

confidence: 99%

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Health literacy interventions for reducing the use of primary and emergency services for minor health problems: a systematic review

O’Cathain

Foster

Preston

et al. 2022

Health Soc Care Deliv Res

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Background Health literacy is the ability to find information, understand information, know how to act on information and know which services to use. Having higher levels of health literacy may help patients to look after minor problems themselves (self-care). It may also help to reduce patients’ perceived need for contacting health services for minor health problems, to reduce the perceived urgency of problems or to improve patients’ ability to identify and choose from the range of available services. Interventions to improve health literacy for minor health problems have been evaluated, but their effectiveness at reducing use of primary care and emergency services has not been synthesised. Objectives The key objectives were as follows: (1) to construct a typology of interventions that aim to reduce primary or emergency care use, (2) to synthesise evidence of the effectiveness of different types of health literacy interventions and (3) to consider how stakeholders in the UK could operationalise the evidence. Interventions The interventions being reviewed were initiatives that help members of the population to self-care or make decisions about whether or not and where to seek health care for minor health problems. Design This study was a systematic review with stakeholder involvement. Data sources and review methods A meeting was held with 14 stakeholders (including patients, carers and the public) to guide the systematic review. This was followed by a multicomponent review of quantitative and qualitative research. Database literature searches were undertaken in Ovid MEDLINE, The Cochrane Library (via Wiley Interscience), EMBASE (via OVID), the Cumulative Index to Nursing and Allied Health Literature (via EBSCO), PsycINFO (via OVID), Web of Science and Sociological Abstracts. The search was limited to English-language publications from 1990–2020. To assess study quality, the Cochrane Risk of Bias tool was used for randomised controlled trials and the Newcastle–Ottawa Scale was used for non-randomised studies. A narrative synthesis was undertaken. The review was followed by a meeting with 16 stakeholders to interpret the results. Results A total of 67 articles (64 studies) were included: 37 from the USA, 16 from the UK, 12 from the rest of Europe and two from the rest of the world. There were seven intervention types: navigation tools directing people to the range of services available (n = 7); written education about managing minor health problems in booklet or website format (n = 17); person-delivered education (n = 5); written education with person-delivered education (n = 17); multicomponent of written education, person-delivered education and mass media campaign (n = 5); self-triage (n = 9); and other (n = 7). Our team assessed the readability and user-friendliness of interventions, and found that these varied widely. When assessed, most studies measuring satisfaction with the intervention, enablement and perceived changes to behaviour showed positive results. Of 30 articles reporting impact on emergency department attendances, 19 (63%) showed a reduction, and 16/27 (59%) articles measuring impact on general practice consultations showed a reduction. Variation in the evidence base was not explained by any research, context or intervention characteristics. Only eight articles measured safety: these identified no problems. Limitations There was inconsistency in how the outcomes were measured, so a meta-analysis was not possible. Conclusions Health literacy interventions have potential to affect emergency and primary care use, but the evidence base is inconsistent. Future research It is important to continue to evaluate these types of initiatives. Study registration This study is registered as PROSPERO CRD42020214206. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 38. See the NIHR Journals Library website for further project information.

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