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Good morning folks, I've just been listening to this morning's news report of a study which tested the UK "NHS Direct" [phone-in medical advice service]. (The test was carried out by callers describing pretended medical problems, and evaluating the interactions which they experienced. Apparently the case which stimulated the media interest was that of a man seeking information about getting a repeat prescription of angina relief tablets; the caller was primed, had he been asked the right questions, to provide information which would have indicated clearly that his "condition" was worsening seriously and he should see a proper doctor immediately; this did not happen). I'm concerned about some of the background which emerged in the news report. It seems that the system works on the basis that the caller is first connected to a "call handler", apparently not clinically qualified, who may then refer the call either to a clinical nurse or to a general information service (e.g. as in the above case where you could get your repeat tablets from). The call-handlers for sure, and possibly the nurses also (though this was not clear), apparently do not in the first place listen properly to what the caller has to say, but follow prompts generated by computer software. It seems, however, that once the caller is speaking to a nurse it is not unlikely that a better interaction will occur. The computer software, it seems, comes in several flavours, some imported from the US. The NHS say thay "have trialled three different sorts of software". Now my questions: What confidence could one have in the medical evidence base which is encapsulated in the computer software? How could one find out what that may be? [Echoes in my mind of the "point-and-click" methodology, bypassing thought, for evaluating clinical trial outcomes by standard statistical software packages.] Tailpiece: A spokesman for the NHS Direct setup said that "There were serious design flaws in the study. There was no control, for instance." [Control??? Do the Automobile Association, for instance, need a Control Group when they investigate whether repair garages fail to detect or properly or economically repair deliberately created faults in test cars submitted for overhaul and repair? Forsooth.] Well, there we are. Now for the rest of the day ... Ted. -------------------------------------------------------------------- E-Mail: (Ted Harding) <[log in to unmask]> Fax-to-email: +44 (0)870 284 7749 Date: 08-Aug-00 Time: 09:23:00 ------------------------------ XFMail ------------------------------ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%