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PP58 Case management of people who call 999 frequently – qualitative study of the perspective of people providing and receiving care (STRETCHED)
  1. Alison Porter1,
  2. Rabeea’h Aslam2,
  3. Timothy Driscoll1,
  4. Adrian Edwards2,
  5. Bethan Edwards3,
  6. Bridie Evans1,
  7. Rachael Fothergill4,
  8. Penny Gripper3,
  9. Imogen Gunson5,
  10. Shaun Harris1,
  11. Heather Hughes3,
  12. Ann John1,
  13. Ashra Khanom1,
  14. Ceri Phillips1,
  15. Rhys Pockett1,
  16. Nigel Rees6,
  17. Robin Petterson6,
  18. Jason Scott7,
  19. Bernadette Sewell1,
  20. Helen Snooks1,
  21. Anna Tee8,
  22. Alan Watkins1
  1. 1Swansea University, UK
  2. 2Cardiff University, UK
  3. 3Public contributor, UK
  4. 4London Ambulance Service NHS Trust, UK
  5. 5West Midlands Ambulance Service NHS Foundation Trust, UK
  6. 6Welsh Ambulance Services NHS Trust, UK
  7. 7Northumbria University
  8. 8Independent


Background Ambulance services use multidisciplinary cross-service case management in some areas to help meet the needs of people who call 999 frequently. The STRETCHED evaluation of case management for this group in four UK ambulance service areas included a qualitative component to explore experience of care, to identify challenges and opportunities associated with using case management models, and develop theories about how case management works in this population.

Methods We conducted semi-structured interviews with key stakeholders involved in case management, and people with experience of calling 999 frequently. All interviews were recorded and transcribed. Analysis took a data driven thematic approach, and was conducted by a sub-group including public contributors working alongside researchers. We analysed by respondent group and by site, before combining and exploring themes across the participant groups.

Results We interviewed 31 stakeholders and 16 people with experience of calling 999 frequently, of which 8 had received case management in one of the study sites. We developed the following themes:

  • The work of case management - within and across organisations, administrative and support tasks, resourcing and skill mix, variation between service areas

  • Complexity of needs – range of drivers for frequent calling, complex medical and social needs, long term nature of issues for many, tensions between cure (short term) and care (long term) models of service

  • Limited availability of support services – as a driver to frequent calling, and as a limitation on case management

  • Tolerance of risk and ownership of responsibility – response to needs shaped by local organisational culture and practice. We used insights from the analysis to refine our logic model describing how case management works.

Conclusion Insight from the qualitative data collection supports interpretation of the STRETCHED quantitative findings and provides insight into how case management might be effective for people who frequently call 999.

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