The intervention aims to reduce avoidable Emergency Department attendances by sending a personal letter to people who have recently attended an Emergency Department, but whose health concerns could likely have been dealt with elsewhere.
Several trials in the US have evaluated the effect of information and mailing interventions on emergency department visits. A trial in a paediatric emergency department gave families receiving Medicaid information about the importance of primary care provision and helped families make appointments. (Grossman, Rich, & Johnson, 1998) This decreased emergency department attendances by 11.1% over the six months following the intervention, however, there was no difference in utilisation between six and 24 months after the intervention. In a different trial, nearly 7000 households receiving Medicaid were randomly selected to be sent a booklet with information about common non-urgent conditions, encouraging the use of alternatives to emergency care, such as GPs, telephonic nurse advice, and self-care (Rector, Venus, & Laine, 1999). The intervention did not significantly reduce attendance at emergency departments. Both studies look at quite specific populations and the results may not be applicable in the UK NHS system. This trial presents information in a more concise and targeted way in order to avoid information overload.
To date, there have been various attempts to provide general information to NHS users about the alternatives to emergency departments. The most obvious examples are the regional ‘Choose Well’ programmes. The ‘Choose Well’ campaign is a national NHS initiative which aims to give people information so that they know where to go to find help with their health concerns, and how to care for themselves if they have a common illness or ailment. However, the campaign merely provides general information that is not linked to individual behaviour. This trial aims to provide patients who have recently made an avoidable visit to A&E with clear and simple information about what to do when an urgent care problem arises.
Grossman, L. K., Rich, L. N., & Johnson, C. (1998). Decreasing nonurgent emergency department utilization by Medicaid children. Pediatrics, 102(1), 20–24.
Rector, T. S., Venus, P. J., & Laine, A. J. (1999). Impact of mailing information about nonurgent care on emergency department visits by medicaid beneficiaries enrolled in managed care. American Journal of Managed Care, 5, 1505–1512.