Cook E J, Randhawa G, Guppy A, Large S
Department of Psychology, University of Bedfordshire, Luton, UK.
Institute for Health Research, University of Bedfordshire, Luton, UK.
BMJ Open. 2015 May 11;5(5):e007533. doi: 10.1136/bmjopen-2014-007533.
The presented study aimed to explore referral patterns of National Health Service (NHS) Direct to determine how patients engage with telephone-based healthcare and how telephone-based healthcare can manage urgent and emergency care.
NHS Direct, England, UK PARTICIPANTS: NHS Direct anonymised call data (N=1,415,472) were extracted over a representative 1-year period, during the combined month periods of July 2010, October 2010, January 2011 and April 2011. Urgent and emergency calls (N=269,558; 19.0%) were analysed by call factors and patient characteristics alongside symptom classification. Categorical data were analysed using the χ(2) test of independence with cross-tabulations used to test within-group differences.
Urgent and emergency referrals to 999; accident and emergency or to see a general practitioner urgently, which are expressed as call rate per 100 persons per annum. Outcomes related to symptom variations by patient characteristics (age, gender, ethnicity and deprivation) alongside differences by patient characteristics of call factors (date and time of day).
Urgent and emergency referrals varied by a range of factors relating to call, patient and symptom characteristics. For young children (0-4), symptoms related to 'crying' and 'colds and flu' and 'body temperature change' represented the significantly highest referrals to 'urgent and emergency' health services symptoms relating to 'mental health' alongside 'pain' and 'sensation disorders' represented the highest referrals to urgent and emergency health services for adults aged 40+ years.
This study has highlighted characteristics of 'higher likelihood' referrals to urgent and emergency care through the delivery of a national nurse-led telephone healthcare service. This research can help facilitate an understanding of how patients engage with both in and out of hours care and the role of telephone-based healthcare within the care pathway.
本研究旨在探究英国国家医疗服务体系（NHS）Direct的转诊模式，以确定患者如何使用基于电话的医疗服务，以及基于电话的医疗服务如何管理紧急和急诊护理。
英国英格兰的NHS Direct
在具有代表性的1年期间（2010年7月、2010年10月、2011年1月和2011年4月这几个月的组合时间段）提取了NHS Direct的匿名呼叫数据（N = 1,415,472）。对紧急和急诊呼叫（N = 269,558；19.0%）按呼叫因素、患者特征以及症状分类进行了分析。使用独立性χ(2)检验对分类数据进行分析，并使用交叉列表来检验组内差异。
紧急和急诊转诊至999；急诊或紧急就诊全科医生，以每年每100人的呼叫率表示。结局涉及按患者特征（年龄、性别、种族和贫困程度）划分的症状差异，以及按呼叫因素的患者特征（一天中的日期和时间）划分的差异。
紧急和急诊转诊因一系列与呼叫、患者和症状特征相关的因素而有所不同。对于幼儿（0 - 4岁），与“哭闹”、“感冒和流感”以及“体温变化”相关的症状是转诊至“紧急和急诊”医疗服务的显著最高比例症状；对于40岁及以上成年人，与“心理健康”以及“疼痛”和“感觉障碍”相关的症状是转诊至紧急和急诊医疗服务的最高比例症状。
本研究通过提供一项由护士主导的全国性基于电话的医疗服务，突出了转诊至紧急和急诊护理的“更高可能性”特征。这项研究有助于促进对患者如何使用非工作时间内外的护理以及基于电话的医疗服务在护理路径中的作用的理解。
