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Disadvantaged populations
Advice given by NHS Direct in Wales: do deprived patients get more urgent decisions? Study of routine data
  1. Julie Peconi1,
  2. Steven Macey2,
  3. Sarah Rodgers1,
  4. Ian Russell1,
  5. Helen Snooks1,
  6. Alan Watkins1
  1. 1 Swansea University Medical School, Institute of Life Sciences 2 (ILS2), Swansea University, Swansea, UK
  2. 2 Action on Smoking and Health (ASH) Wales, Cardiff, UK
  1. Correspondence to Julie Peconi, Institute of Life Sciences 2 (ILS 2), Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, Wales, UK; j.peconi{at}swansea.ac.uk

Abstract

Background In the UK, National Health Service Direct Wales (NHSDW) uses computerised decision support software to advise patients on appropriate care. However, the effect of deprivation on the advice given is not known. We aimed to estimate the effect of deprivation on advice given by nurses in NHSDW adjusting for confounding variables.

Methods We included 400 000 calls to NHSDW between January 2002 and June 2004. We used logistic regression to model the effect of deprivation on advice given by nurses in response to calls seeking advice or information. We analysed two outcomes: receiving advice to phone 999 emergency care rather than to seek other care and receiving advice to seek care face to face rather than self-care.

Results After adjustment for covariates, an increase in deprivation from one-fifth of the distribution to the next fifth increased by 13% the probability that those calling for advice rather than information received advice to phone 999 (OR 1.127; 95% CI from 1.113 to 1.143). Deprivation increased the corresponding probability of being advised to seek care face to face rather than self-care by 5% (OR 1.049; 95% CI from 1.041 to 1.058) within advice calls and by 3% (OR 1.034; 95% CI from 1.022 to 1.047) within information calls.

Conclusions Deprivation increased the chance of receiving more urgent advice, particularly advice to call 999. While our dataset may underestimate the ‘need’ of deprived patients, it yields no evidence of major inequity in advice given to these patients.

  • telemedicine
  • hotlines
  • health services needs and demand
  • poverty areas
  • socioeconomic factors
  • vulnerable populations

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/jech-2017-208978

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    Footnotes

    • Contributors JP and HS designed the study. JP cleaned, managed and analysed the data, drafted and revised the paper. She is the guarantor. SM provided expertise in informatics, SR expertise in medical geography, IR and AW expertise in statistics and HS expertise in the field of emergency care research. All authors revised the draft paper.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval South East Wales Local Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement A more detailed description of the data is contained in Dr Julie Peconi's PhD Thesis ‘The epidemiology of demand for and outcomes of contacts with telephone based healthcare with particular reference to ward deprivation scores: Analysis of calls to NHS Direct Wales 2002–2004’. Please contact j.peconi@swansea.ac.uk for more details.