OA32 A national survey of rheumatology telephone adviceline support in the United Kingdom: frontline perspectives
Authors: Ryan Sarah , Hider Samantha , Hassell Andrew 
Published: April 2024

Abstract

Background/Aims
Telephone advicelines (TALs) are a core feature of rheumatology services and highly valued by patients for providing clinical advice and support. The demand for TALs has increased since the pandemic, placing pressure on current capacity. This study aimed to assess how TALs are currently provided and the impact on rheumatology nurses who routinely deliver this service.

Methods
An online questionnaire was developed and piloted with input from patients and stakeholders and advertised through the Royal College of Nursing Rheumatology Forum and the British Society for Rheumatology. The survey included health professional demographics, how TALs operate, reasons for contacting TALs, documentation recorded and the impact on provider wellbeing using closed and free text questions. The survey was available from March to September 2023 and had university ethics approval.

Results
123 people completed the survey. The majority were rheumatology nurses (n = 118), over 45yrs (n = 96,81%), band 7 or above (n = 88;74%) with over 10 years experience (n = 77,65%), with a first degree or higher (n = 106, 90%). 45 (38%) nurses had a prescribing qualification. The majority of TALs provided a voicemail response (n = 90, 76%),with a triaging system (n = 75, 64%) conducted by clinical support workers (n = 44, 37%) and nurses (n = 29,25%). The number of calls received over a month ranged from 100 to over 800 with 68 (58%) respondents reporting between 500-700 calls. TALs were provided over 5 days (n = 93,79%) for 8 hours (n = 61, 52%), by rheumatology nurses (n = 118), with calls returned within 1-2 days (n = 96,81%) by 1-2 nurses (n = 72,61%), although some calls took over 7 days to respond to (n = 19). The three main reasons for contacting TALs included increased disease activity, managing pain, and concerns relating to DMARDs. There was often no standard operating procedure (n = 72, 61%) or provision for people whose first language is not English (n = 99,84%). Data were collected on the nature of the call (n = 74, 63%) and the response given (n = 47, 40%). Providing TALs negatively impacted on provider wellbeing; 89 (75%) felt anxious ‘sometimes to mostly’ and 79 (67%) found it ‘mostly-always’ stressful. 85 (72%) had not received any training to conduct TALs and 79 (67%) reported that cover was often not available for leave or sickness. The qualitative findings also confirmed that expert providers found delivering TALs stressful and felt underprepared. One respondent commented that “The adviceline is the most stressful aspect of the role but has the least support.” Many felt the adviceline had developed without adequate planning, contributing to the service being under resourced and under recognised.

Conclusion
TALs support patients with concerns about their symptoms and treatments on a daily basis, yet the increased demand for delivering TALs is impacting on nurse wellbeing. Consequently, national guidelines are required on optimal service requirements including resource allocation, training and health professional support.

Disclosure
S. Ryan: None. S. Hider: None. A. Hassell: None.