Medical School, Swansea University, Swansea, UK
Welsh Government, Swansea, UK.
BMJ Open. 2019 Oct 11;9(10):e029203. doi: 10.1136/bmjopen-2019-029203.
To estimate the effect of deprivation on the demand for calls to National Health Service Direct Wales (NHSDW) controlling for confounding factors.
Study of routine data on over 400 000 calls to NHSDW using multiple regression to analyse the logarithms of ward-specific call rates across Wales by characteristics of call, patient and ward, notably the Welsh Index of Multiple Deprivation.
810 electoral wards with average population of 3300, defined by 1998 administrative boundaries.
All calls to NHSDW between January 2002 and June 2004.
We used ward populations as denominators to calculate the rates of three categories of calls: calls seeking advice, calls seeking information and all calls combined.
Confounding variables explained 31% of variation in advice call rates, but only 14% of variation in information call rates and in all call rates (all significant at 0.1% level). However, deprivation was only a statistically significant predictor of information call rates. The proportion of the ward population categorised as 'white' was a highly significant predictor of all three call rates. For advice calls and combined calls, rates decreased highly significantly with the proportion of those who called the service for themselves. Information call rates were higher on weekdays and highest on Mondays, while advice call rates were highest on Sundays.
Deprivation had no consistent effect on demand for the service and the relationship needs further exploration. While our data may have underestimated the 'need' of deprived patients, they yield no evidence that policy-makers should seek to improve demand from those patients. However, we found differences in the way callers use advice and information calls. Previously unexplored variables that help to predict ward-specific call rates include: ethnicity, day of the week and whether patients made the calls themselves.
在控制混杂因素的情况下，估计剥夺对国民保健署直接威尔士（NHSDW）呼叫需求的影响。
使用多元回归分析威尔士 810 个选区超过 40 万次 NHSDW 呼叫的常规数据，分析按呼叫、患者和病房特征（包括威尔士多重剥夺指数）划分的威尔士各病房特定呼叫率的对数。
810 个选区，每个选区的平均人口为 3300 人，由 1998 年的行政边界定义。
2002 年 1 月至 2004 年 6 月间 NHSDW 的所有呼叫。
我们使用病房人口作为分母，计算了三类呼叫的比率：寻求建议的呼叫、寻求信息的呼叫和所有呼叫的总和。
混杂变量解释了咨询呼叫率变化的 31%，但仅解释了信息呼叫率和所有呼叫率变化的 14%（均在 0.1%水平上显著）。然而，剥夺只是信息呼叫率的一个统计学上显著的预测因子。将病房人口分类为“白人”的比例是所有三种呼叫率的高度显著预测因子。对于咨询呼叫和组合呼叫，随着自行拨打服务电话的比例的增加，呼叫率显著下降。信息呼叫率在工作日较高，周一最高，而咨询呼叫率周日最高。
剥夺对服务需求没有一致的影响，这种关系需要进一步探讨。虽然我们的数据可能低估了贫困患者的“需求”，但没有证据表明政策制定者应该寻求提高这些患者的需求。然而，我们发现呼叫者使用咨询和信息呼叫的方式存在差异。以前未被探索的有助于预测病房特定呼叫率的变量包括：种族、星期几以及患者是否自行拨打了电话。
