Title: Expanding the role of NHS Direct in the management of long-term conditions
Funder: Department of Health (England)

Abstract: AIMS & OBJECTIVES Aim: to develop, implement and evaluate new interventions via NHS Direct for patients with long-term conditions (LTCs) and to provide evidence about benefits and costs. Objectives: to synthesise evidence about telehealth for LTCs in order to maximise the potential of NHS Direct in supporting LTC management; to explore relationships between access to care, need and willingness to use NHS Direct; to develop interventions based on NHS Direct; to determine clinical & cost-effectiveness of LTC management provided by NHS Direct in 2 exemplar conditions of high cardiovascular risk and depression. BACKGROUND The priority for the NHS is increasingly to help people manage LTCs. We need new ways of working which improve access and care quality and efficiently support large numbers of people to self-manage. There is international interest in the role of telehealth (e.g. internet, telephone, remote monitoring) in managing LTCs. Although there is evidence of effectiveness for different interventions, this depends on health condition, patient population and health system context. Evidence about cost-effectiveness is limited. Current provision of telehealth is fragmentary. NHS Direct provides an established platform which could integrate a range of new technologies in providing care for LTCs. This may be particularly helpful to people who have difficulty accessing face-to-face care. RESEARCH PLANS Our programme consists of 5 linked activities: 1. Review and synthesis of quantitative and qualitative evidence about telehealth for patients with LTCs, in order to develop a theory about which types of intervention potentially delivered by NHS Direct are most likely to be effective. 2. Qualitative research with patients and health professionals to examine how NHS Direct can best contribute to LTC management 3. Survey of patients with 2 exemplar LTCs (high cardiovascular risk, depression) to explore relationships between access to care, unmet need and willingness to use NHS Direct; specifically types of telehealth most likely to be acceptable to different patient groups 4. Development of interventions for our exemplar LTCs to be offered by NHS Direct which, based on activities 1 to 3 above, are likely to be acceptable, effective and efficient 5. Randomised trial to determine effectiveness of LTC management provided by NHS Direct in 2 exemplar conditions. We will also use qualitative methods to study implementation and conduct economic evaluation to assess cost-effectiveness and model future costs/benefits following national implementation RESEARCH TEAM A partnership of academics and service providers which combines relevant topic specific and methodological expertise. We have successfully collaborated on many previous projects. The research team is supported by an advisory group which includes principal investigators of other relevant ongoing studies. RESEARCH ENVIRONMENT NHS Direct is fully committed to this project which supports its strategic plans. Members of the research team come from leading centres of primary care research. Bristol & Manchester are members of the NIHR School for Primary Care Research, in which managing LTCs is a core theme. Sheffield has a portfolio of research about telehealth and NHS Direct. OUTPUTS, OUTCOMES & IMPACT This programme: • provides a summary of evidence for commissioners about how telehealth interventions can improve care of LTCs and a theoretical basis for future development of interventions • identifies types of interventions which if delivered by NHS Direct are likely to be acceptable to patients and the groups of patients most likely to need and use them • builds on existing telehealth interventions for which there is already proof of concept to develop programmes of care to be delivered by NHS Direct. • provides robust evidence about the implementation, costs and benefits of these LTC programmes. Basing interventions on theory and paying attention to context and implementation means that if successful these and similar interventions for other LTCs can quickly be rolled out via existing NHS Direct infrastructure to benefit large numbers of people by facilitating self-management and improving health outcomes, patient experience and efficiency. PUBLIC INVOLVEMENT NHS Direct has an active user group. Two users were involved in the development of this proposal and will be involved in the project advisory group. Other users with LTCs will be recruited to assist in developing the intervention. Users will be supported & trained to enable them to contribute effectively. ETHICAL IMPLICATIONS We do not anticipate particular ethical problems We recognise the importance of NHS Direct supporting and liaising with patients’ general practitioners, who retain overall clinical responsibility. JUSTIFICATION FOR RESOURCES Budget is allowed for applicants time; research staff salaries; travel, consumables & equipment; development of new telehealth content at NHS Direct.????


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE;MENTAL HEALTH;CARDIOVASCULAR