Centre for Health Information, Research and Evaluation (CHIRAL), School of Medicine, Swansea University, Singleton Park, Swansea SA2 8PP, UK.
BMC Health Serv Res. 2009 Sep 30;9:178. doi: 10.1186/1472-6963-9-178.
An evaluation of NHS Direct Wales (NHSDW), a national telephone-based healthcare advice and information service, was undertaken. A key objective was to describe the actions of callers and assess the appropriateness of advice and healthcare contacts made following calls, results of which are reported here.
Postal questionnaires were sent to consecutive callers to NHSDW in May 2002 and February 2004 to determine 1) callers' actions following calls and 2) their views about the appropriateness of: advice given; and when to seek further care. An independent clinical panel agreed and applied a set of rules about healthcare sites where examinations, investigations, treatments and referrals could be obtained. The rules were then applied to the subsequent contacts to healthcare services reported by respondents and actions were classified in terms of whether they had been necessary and sufficient for the care received.
Response rates were similar in each survey: 1033/1897 (54.5%); 606/1204 (50.3%), with 75% reporting contacting NHSDW. In both surveys, nearly half of all callers reported making no further healthcare contact after their call to NHSDW. The most frequent subsequent contacts made were with GPs.More than four fifths of callers rated the advice given - concerning any further care needed and when to seek it - as appropriate (further care needed: survey 1: 673/729, 82.3%; survey 2: 389/421, 92.4%; when to seek further care - survey 1: 462/555, 83.2%; survey 2: n = 295/346, 85.3%). A similar proportion of cases was also rated through the rule set and backed up by the clinical panel as having taken necessary and sufficient actions following their calls to NHSDW (survey 1: 624/729, 80.6%; survey 2: 362/421, 84.4%), with more unnecessary than insufficient actions identified at each survey (survey 1: unnecessary 132/729, 17.1% versus insufficient 11/729, 1.4%; survey 2: unnecessary 47/421, 11.0% versus insufficient 14/421, 3.3%).
Based on NHSDW caller surveys responses and applying a transparent rule set to caller actions a large majority of subsequent actions were assessed as appropriate, with insufficient contacts particularly infrequent. The challenge for NHSDW is to reduce the number of unnecessary contacts made following calls to the service, whilst maintaining safety.
对全国性的电话医疗咨询和信息服务 NHS Direct Wales（NHSDW）进行了评估。主要目的是描述来电者的行为，并评估来电后的咨询和医疗接触的适当性，结果报告如下。
2002 年 5 月和 2004 年 2 月，向 NHSDW 的连续来电者邮寄了调查问卷，以确定 1）来电者在来电后的行为；2）他们对以下内容的看法：给出的建议；以及何时寻求进一步的护理。一个独立的临床小组同意并应用了一套关于可以获得检查、调查、治疗和转诊的医疗场所的规则。然后，将这些规则应用于受访者报告的随后与医疗保健服务的接触，并根据这些接触是否对所接受的护理是必要和充分的，对这些接触进行分类。
两次调查的回复率相似：1033/1897（54.5%）；606/1204（50.3%），其中 75%的人报告拨打了 NHSDW。在两次调查中，几乎一半的来电者在拨打 NHSDW 后没有再联系其他医疗服务。最常见的后续接触是与全科医生。超过五分之四的来电者认为所提供的建议——关于任何进一步的护理需求以及何时寻求护理——是适当的（进一步护理需求：调查 1：729/729，82.3%；调查 2：421/421，92.4%；何时寻求进一步的护理——调查 1：555/555，83.2%；调查 2：n=346/346，85.3%）。通过规则集和临床小组评估，也有类似比例的病例被认为在拨打 NHSDW 后采取了必要和充分的行动（调查 1：729/729，80.6%；调查 2：421/421，84.4%），每个调查都发现了更多不必要的行动而不是不足的行动（调查 1：不必要 132/729，17.1%与不足 11/729，1.4%；调查 2：不必要 47/421，11.0%与不足 14/421，3.3%）。
根据 NHSDW 来电者调查的回复，并应用透明的规则集来评估来电者的行为，大多数后续行动被评估为适当的，而不足的接触则特别罕见。NHSDW 的挑战是减少服务来电后的不必要接触数量，同时保持安全性。
