Satisfaction of using a nurse led telephone helpline among mothers and caregivers of young children

Highlights

• Nurse led triage can equip patients with the skills and knowledge to self manage health symptoms.

• Self-care support can empower patients to take more control of theirs and others health.

• Quality of communication is integral to patients trust and reassurance of this type of service.

Abstract

Objectives

This research aimed to explore user’s experiences of using a nurse led telephone based healthcare service (NHS Direct) among mothers and caregivers of young children to uncover the core factors, which influence the level of satisfaction of using this type of service.

Methods

Focus groups were held with a subgroup of NHS Direct high ‘users’ (N=17), which included mothers and grandmothers of young children aged between 21 and 54 years old. Qualitative data analysis was undertaken using the thematic framework approach.

Results

The findings revealed a high level of satisfaction towards this service and this was based on high levels of trust and reassurance that this service provides. Findings also uncovered that users believed that the service would be improved by the utilisation of more person-centred decision-making tools.

Conclusion

This research demonstrates the increasing role that telephone based healthcare services can play on empowering patients to take more control of their health.

Introduction

Telephone based healthcare has become an intrinsic part of healthcare both in the UK [1] and worldwide [2], [3], [4], [5]. NHS Direct, created in 1998, soon became a leading example of this, acclaimed as the largest and most successful telephone based healthcare provider of its kind worldwide [6], [7], taking on average, about 100,000 calls each week [8]. This nurse-led triage service provided the population in England and Wales health advice and information 24  hours a day, 7 days a week, supporting the public to care for themselves and/or access appropriate health care if necessary [1]. NHS Direct ceased to operate on 31 March 2014 and has since been replaced with the new non-emergency NHS 111 service [9], [11]. This service, also telephone based, was introduced to simplify access to non-emergency health care. It has been designed to act as a ‘filter’ for all non-emergency (but urgent) calls, used to triage and support callers to manage symptoms or signpost callers who are unsure about what service they need [12]. As such it remains clear that telephone based triage services remain core to the health strategy within the NHS, where we can apply lessons learnt from NHS Direct to the new NHS 111 service [13].

NHS Direct supported patients through a nurse-led clinical assessment to care for themselves at home, alongside providing information on local health services and support organisations, advice on maintaining a healthy lifestyle, information surrounding illnesses, conditions and any related medical information [14]. Evidence has suggested that NHS Direct has empowered patients, through legitimising help-seeking actions of ‘users’ enabling them to make more informed decisions about the appropriateness of seeking healthcare, either for themselves or others [15]. Evidence related to user-experience has been mixed, whilst some users suggested high levels of satisfaction [16], [17], concerns have been raised from some ‘users’ which related to difficulties getting through to a health advisor on the phone and waiting for a long periods of time for a call back by a nurse, both of which negatively impacted on satisfaction [18].

It is widely accepted that patient satisfaction and service quality are fundamental to the development of service improvement strategies [19], often seen as the pinnacle marker of a successful healthcare service [20]. However the continued challenges to define, standardised and measure satisfaction have led to the debate that research should instead focus on health service quality [21]. Moreover, theoretical assumptions are largely based on traditional healthcare services which depend on face-to-face interaction between the patient and provider [22] formed around expectations and continuity of care [23] which limits applicability to more innovative healthcare services [24]. Patient satisfaction in the context of telephone based health services has demonstrated favourable results [25]. However, the evidence is inconclusive as many studies have lacked good quality rigorous evaluative data [26], often not based on a clear definition of satisfaction [27] or reported satisfaction as an outcome [6].

In light of the evidence more qualitative approaches are needed to determine what factors impact on satisfaction and how this impacts on the decision to uptake the this type of service. Qualitative approaches offer the benefit to uncover a more in-depth insight of healthcare quality particularly in groups that share common views and opinions, as opposed to depending upon fixed questionnaires [28]. Moreover, much of the research to date has depended on patient surveys, which do not have the ability to uncover factors and influences that influence satisfaction, which qualitative methodologies have the ability to do. The presented study, addresses this gap providing the first qualitative investigation, which focuses on a subgroup of NHS Direct ‘high users’, namely mothers and caregivers of young children, to uncover the core factors that can influence levels of satisfaction of a telephone healthcare service.