NHS Direct derived data: an exciting new opportunity or an epidemiological headache?
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NHS Direct, a national telephone helpline for health advice, was established in 1998 to provide health information and advice to callers and refer them to an appropriate service. This article briefly describes the nature of the NHS Direct call record and discusses issues relevant to the use of the data for disease surveillance and epidemiological purposes. Clinical decision support software [the NHS Clinical Assessment System (NHS CAS)] is used by NHS Direct to collect callers' demographic details and direct them to the appropriate level of care. Data relating to NHS Direct calls provide a timely snapshot of symptoms occurring in the community and are summarized in 'off the shelf' NHS CAS reports. Adapting the system to provide customized data extracts requires considerable development work. When interpreting NHS Direct derived data, particular attention should be given to the age distribution of callers, NHS Direct demand surges, call 'networking' and changes to the NHS CAS clinical algorithms. An increasingly rich source of baseline data, growing body of published work, and a more 'bedded down' NHS Direct service will further our understanding and acceptance of the value of the NHS Direct call record. (+info)
Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.
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OBJECTIVE: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. DESIGN: Cluster randomised controlled trial. SETTING: Five healthcare organisations in the United States and 60 affiliated practices. PATIENTS: 405 patients, aged > or = 18 years, starting or changing treatment for depression. INTERVENTION: Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist. MAIN OUTCOME MEASURES: Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5). RESULTS: At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003). CONCLUSION: Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression. (+info)
A comparison of two methods of analog-to-digital medical video conversion.
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The purpose of this study was to compare 2 methods of analog-to-digital video conversion in anticipation of improving, refining, and standardizing digital video production for medical education, diagnosis support, and telemedicine. A video workstation was devised containing 2 analog-to-digital video conversion systems: a digital video media converter with fire wire card and a video capture card. A procedure for final digital video production was created that used equivalent compression, pixel resolution, frame rate, and data rate for both systems. A subjective test was performed in which 12 archived analog videotapes, consisting of magnetic resonance angiograms, ultrasounds, neurosurgeries, and telemedicine applications, were converted digitally using the 2 methods. Randomized side by side video comparisons were analyzed and rated by subjective quality. An objective test was performed by videotaping a gray-scale test pattern off a computer monitor, digitally converting it by the 2 methods, and comparing the gray-scale values to the original pattern. There was no significant difference in overall video quality (P = .31) or grayscale reproduction using the 2 methods of analog-to-digital conversion. When performing simple analog-to-digital video conversion, a video capture card is equal in quality and costs less than a digital video (DV) media converter or fire wire card. If a digital video camera is available for use, then a DV media converter or fire wire card is more advantageous because it enables full operation of the digital video camera. (+info)
Safety of telephone consultation for "non-serious" emergency ambulance service patients.
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OBJECTIVE: To assess the safety of nurses and paramedics offering telephone assessment, triage, and advice as an alternative to immediate ambulance dispatch for emergency ambulance service callers classified by lay call takers as presenting with "non-serious" problems (category C calls). DESIGN: Data for this study were collected as part of a pragmatic randomised controlled trial reported elsewhere. The intervention arm of the trial comprised nurse or paramedic telephone consultation using a computerised decision support system to assess, triage, and advise patients whose calls to the emergency ambulance service had been classified as "non-serious" by call takers applying standard priority dispatch criteria. A multidisciplinary expert clinical panel reviewed data from ambulance service, accident and emergency department, hospital inpatient and general practice records, and call transcripts for patients triaged by nurses and paramedics into categories that indicated that dispatch of an emergency ambulance was unnecessary. All cases for which one or more members of the panel rated that an emergency ambulance should have been dispatched were re-reviewed by the entire panel for an assessment of the "life risk" that might have resulted. SETTING: Ambulance services in London and the West Midlands, UK. STUDY POPULATION: Of 635 category C patients assessed by nurses and paramedics, 330 (52%) cases that had been triaged as not requiring an emergency ambulance were identified. MAIN OUTCOME MEASURES: Assessment of safety of triage decisions. RESULTS: Sufficient data were available from the routine clinical records of 239 (72%) subjects to allow review by the specialist panel. For 231 (96.7%) sets of case notes reviewed, the majority of the panel concurred with the nurses' or paramedics' triage decision. Following secondary review of the records of the remaining eight patients, only two were rated by the majority as having required an emergency ambulance within 14 minutes. For neither of these did a majority of the panel consider that the patient would have been at "life risk" without an emergency ambulance being immediately dispatched. However, the transcripts of these two calls indicated that the correct triage decision had been communicated to the patient, which suggests that the triage decision had been incorrectly entered into the decision support system. CONCLUSIONS: Telephone advice may be a safe method of managing many category C callers to 999 ambulance services. A clinical trial of the full implementation of this intervention is needed, large enough to exclude the possibility of rare adverse events. (+info)
Quantitative and qualitative usage data of an Internet-based asthma monitoring tool.
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BACKGROUND: In May 2000, AstraZeneca launched a Web service for asthma patients and health-care providers called LinkMedica, which includes an asthma diary for monitoring and self-management. In the diary, the patient enters his or her peak flow, number of doses of rescue medication, and if there have been any asthma symptoms during the previous 24 hours. The patient receives an immediate response from LinkMedica, telling him or her if the asthma is under control and what to do if not, eg, increase the dose of inhaled steroid. Health-care providers have access to the patient diary. OBJECTIVES: The primary objective of the study was to describe patients' and health-care providers' use of LinkMedica. Secondary objectives were to evaluate their perception of the system and how the users' interaction with the system is influenced by their everyday lives. METHODS: Site statistics regarding number of registered users and diary usage were analyzed. An online survey among users (85 respondents), a mailed questionnaire to health-care providers (131 respondents; response rate 26.8%), as well as in-depth interviews with 10 patients and 5 general practitioners, elicited further quantitative and qualitative data on users' perceptions. RESULTS: In February 2003, a total of 7653 users had registered. During 2002, the growth in registered users averaged 50 per month. In the same period, the number of unique diary users per month decreased from 307 to 138. Patients usually stopped using the diary after a short time; the doctors were reluctant to introduce the diary to patients because of time constraints. Several user subtypes were identified among patients and their relatives. CONCLUSION: The self-selected survey responses and in-depth interviews indicated that LinkMedica is generally considered a trustworthy and reliable site by both patients and doctors. However, there was a contrast between users' positive perception of LinkMedica and their unwillingness to use the site for more than short periods. The primary reason for this was that LinkMedica did not fit into their everyday lives because of technical and psychological aspects. A number of recommendations to improve LinkMedica are suggested. (+info)
Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria.
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BACKGROUND AND PURPOSE: Systemic thrombolysis represents the only proven therapy for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support. METHODS: The stroke centers in Munich-Harlaching and in Regensburg established a telestroke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in which qualified teams treat acute stroke patients. Physicians in these hospitals are able to contact the stroke centers 24 hours per day. RESULTS: A total of 106 systemic thrombolyses were indicated via teleconsultations between February 1, 2003, and April 7, 2004. During the first 12 months, the rate of thrombolyses was 2.1% of all stroke patients. Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admission was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred in 8.5% of patients, and in-hospital mortality was 10.4%. CONCLUSIONS: The present data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reported in the National Institute of Neurological Disorders and Stroke trial. Therefore, tPA treatment is also safe in this context and can be extended to nonurban areas. (+info)
Triage up front.
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OBJECTIVES: To assess the effectiveness of a newly developed triage tool to provide urgent access to genitourinary medicine (GUM) for patients. To appraise its value in compiling statistics for patients attending the department without appointments or those telephoning for advice. METHOD: Retrospective evaluation of triage forms completed by healthcare professional (HCP). Randomly selected triage forms completed for 250 male and 250 female patients attending a GUM clinic over a 3 month period. RESULT: Patients attending or telephoning with acute symptoms such as ulceration or abdominal pain, or as a result of sexual assault were offered same day or next day appointments in 100% of cases. However, for untreated chlamydial infection, testicular pain, and male urethritis the success rate fell to between 54-86%. CONCLUSION: The new form is easy to complete and allows a more structured triage of patients. It provides a standardised template for staff employed in GUM triage and facilitates accurate documentation and data collection of this important activity. All targets are not being met and patient distress is not adequately addressed or recorded to help service planning. However, accountable standardised data can be collected, which is important in defining the extent of the service and provides useful information for commissioners. (+info)
Internet consultations from a remote Pacific island: impact of digitized radiologic images on referral decisions.
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A study was carried out to determine whether digitized radiologic images added valuable information to Internet consultations from a remote Pacific Island. Chuuk State Hospital (Federated States of Micronesia) has limited film screen radiology, minimal ultrasound capability, and no radiologist. Providers initiate Web-based referrals for consultation or patient transfer. Digitized images (via low-cost digital camera or flatbed scanner) were uploaded to a Web site. Images were assessed for impact on referral decisions. A radiologist scored image quality and confidence (scale: 1-7). Of 97 referrals with images that were reviewed, 74 (76%) image sets were abnormal, 20 (20%) were normal, and 3 (4%) were indeterminate. Median scores were 4 for image quality and 5 for diagnostic confidence. In most cases with abnormal radiology (52/74, 70%), images were considered valuable. Radiologic images digitized with a low-cost camera or flatbed scanner provided valuable information for decision making in an Internet-based consultation and referral process from a remote, impoverished Pacific Island jurisdiction, despite relatively low image quality. (+info)