CRediT contribution statement
Alan Watkins (https://orcid.org/0000-0003-3804-1943): Conceptualisation, Data curation, Formal analysis, Funding acquisition, Supervision, Validation, Visualisation, Writing – original draft, Writing – review and editing.
Rabeea’h Aslam (https://orcid.org/0000-0002-0916-9641): Investigation, Project administration, Writing – review and editing.
Alex Dearden (https://orcid.org/0009-0002-8529-0192): Project administration, Writing – original draft, Writing – review and editing.
Timothy Driscoll (https://orcid.org/0000-0001-9879-2509): Data curation, Formal analysis, Methodology, Software, Validation, Writing – original draft, Writing – review and editing.
Adrian Edwards (https://orcid.org/0000-0002-6228-4446): Funding acquisition, Writing – original draft, Writing – review and editing.
Bethan Edwards (https://orcid.org/0000-0001-7413-056X): Conceptualisation, Funding acquisition, Resources, Writing – review and editing.
Bridie Angela Evans (https://orcid.org/0000-0003-0293-0888): Funding acquisition, Supervision, Writing – original draft, Writing – review and editing.
Angela Farr (https://orcid.org/0000-0002-2087-9310): Data curation, Software, Formal analysis, Writing – original draft, Writing – review and editing.
Theresa Foster (https://orcid.org/0000-0002-6395-0885): Investigation, Resources, Writing – review and editing.
Rachael Fothergill (https://orcid.org/0000-0003-1341-6200): Investigation, Resources, Writing – review and editing.
Penny Gripper (https://orcid.org/0009-0002-5957-7843): Conceptualisation, Funding acquisition, Resources, Writing – review and editing.
Imogen M Gunson (https://orcid.org/0000-0001-8335-3335): Investigation, Resources, Writing – review and editing.
Ann John (https://orcid.org/0000-0002-5657-6995): Conceptualisation, Funding acquisition, Writing - review and editing.
Ashrafunnesa Khanom (https://orcid.org/0000-0002-5735-6601): Conceptualisation, Funding acquisition, Investigation, Resources, Writing – original draft, Writing – review and editing.
Tessa Noakes (https://orcid.org/0000-0001-5245-3835): Investigation, Resources, Writing – review and editing.
Robin Petterson (https://orcid.org/0009-0002-3448-9214): Funding acquisition, Resources, Writing – review and editing.
Alison Porter (https://orcid.org/0000-0002-3408-7007): Conceptualisation, Funding acquisition, Investigation, Visualisation Writing – original draft, Writing – review and editing.
Nigel Rees (https://orcid.org/0000-0001-8799-5335): Conceptualisation, Investigation, Resources, Writing – review and editing.
Andy Rosser (https://orcid.org/0000-0002-5477-4269): Investigation, Resources, Writing – review and editing.
Jason Scott (https://orcid.org/0000-0002-6566-8007): Funding acquisition, Methodology, Writing – original draft, Writing – review and editing.
Bernadette Sewell (https://orcid.org/0000-0001-5471-922X): Formal analysis, Writing – original draft, Writing – review and editing.
Anna Tee (https://orcid.org/0009-0009-9564-2391): Funding acquisition, Methodology, Writing – review and editing.
Helen Snooks (https://orcid.org/0000-0003-0173-8843): Conceptualisation, Funding acquisition, Methodology, Supervision, Writing – original draft, Writing – review and editing.
Acknowledgements
The delivery of the research undertaken in STRETCHED and summarised in this report was only possible with the expertise and commitment of a wide range of people and organisations.
We would like to extend our thanks to all who supported this work, and specifically acknowledge the following parties:
The four participating ambulance services and their staff.
Participants in the stakeholder workshop to develop the logic model.
Our Study Steering Committee: Tony Clements (chair); Alan Brown (PPI); Bob McAlister (PPI); Victoria Allgar; Nathan Daxner; Jonathon Hammond-Williams; Leanne Jenkins; Pip Logan; Catherine Pope; Niro Siriwardena.
Our Lived Experience Advisory Panel.
Anne Surman; Neil Jenkinson; Angharad Claydon for administrative support.
Paola Griffiths for guidance on research governance.
Rob Wilson for advice and assistance with the SAIL Gateway Trusted Research Environment.
Ken Smith for his support throughout the study.
Heather Hughes & Ceri Phillips, co-applicants on the funding application.
NIHR HS&DR for funding and Donna White, Justyna Rafalik and Rozz Bloom for supporting this research.
Patient data statement
This work uses data provided by patients and collected by the NHS as part of their care and support. Using patient data is vital to improve health and care for everyone. There is huge potential to make better use of information from people’s patient records, to understand more about disease, develop new treatments, monitor safety, and plan NHS services. Patient data should be kept safe and secure, to protect everyone’s privacy, and it’s important that there are safeguards to make sure that it is stored and used responsibly. Everyone should be able to find out about how patient data are used. #datasaveslives You can find out more about the background to this citation here: https://understandingpatientdata.org.uk/data-citation.
Data-sharing statement
STRETCHED data within SAIL are securely stored within its databank and held in compliance with data retention, archiving and data destruction policies. Applications to access data held within the SAIL databank require approval following independent review by their Information Governance Review Panel (IGRP), and access is subject to SAIL’s terms, conditions and data disclosure and dissemination policies and procedures. All other inquiries on STRETCHED data should be addressed to the corresponding author.
Ethics statement
STRETCHED was approved on 27 May 2020 by the Health Research Authority and Health & Care Research Wales, based on a favourable opinion received on 1 October 2019 from Wales Research Ethics Committee 4 (19/WA/0216) and support on 27 May 2020 from the Confidential Advisory Group (19/CAG/0195).
Information governance statement
Swansea University is the sole Data Controller for STRETCHED and was the sole recipient and Data Processor of data from NHS England and the SAIL databank. The East of England Ambulance Service; London Ambulance Service; West Midlands Ambulance Service; and Welsh Ambulance Service each processed identifiable 999 call data in order to identify the study cohort. Although they are Controllers of the underlying data, they were Processors for the purpose of the STRETCHED study as cohort identification was undertaken under instruction from the Data Controller. Swansea University is committed to handling all personal information in line with the UK Data Protection Act (2018) and the General Data Protection Regulation (EU GDPR) 2016/679, and publishes information on how it handles personal data, including how to exercise individual rights and contact details for its Data Protection Officer.
Disclosure of interests
Full disclosure of interests: Completed ICMJE forms for all authors, including all related interests, are available in the toolkit on the NIHR Journals Library report publication page at https://doi.org/10.3310/PWGF6008.
Primary conflicts of interest: Alan Watkins was a member of HS&DR Funding Committee; Nigel Rees is a member of HTA Clinical Evaluation and Trials Committee; and Helen Snooks is a member of NIHR HTA and EME Editorial Board.
Publications
Snooks HA, Khanom A, Cole R, Edwards A, Edwards BM, Evans BA, Scott J. What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom. BMC Emerg Med 2019;19:82. https://doi.org/10.1186/s12873-019-0297-3
Aslam RW, Snooks H, Porter A, Khanom A, Cole R, Edwards A, Watkins A. STRategies to manage Emergency ambulance Telephone Callers with sustained High needs: an Evaluation using linked Data (STRETCHED) – a study protocol. BMJ Open 2022;12:e053123. https://doi.org/10.1136/bmjopen-2021-053123
Evans BA, Khanom A, Edwards A, Edwards B, Farr A, Foster T, Watkins A. Experiences and views of people who frequently call emergency ambulance services: a qualitative study of UK service users. Health Expect 2023;27. https://doi.org/10.1111/hex.13856
Conference papers and talks
Case management of people who call 999 frequently – qualitative study of the perspective of people providing and receiving care (STRETCHED) – poster at 999EMS Research Forum Annual Conference, 2023.
Case management of people who call 999 frequently – qualitative study of the perspective of people providing and receiving care (STRETCHED) – oral presentation at PRIME Centre Wales Annual Meeting, 2023.
Effects of case management on emergency service usage and mortality of people who call 999 frequently (STRETCHED): emerging Results of linked data analysis – oral presentation at 999EMS Research Forum Annual Conference, 2023.
When is it wrong to ring 999 (again)? Constructing a moral narrative around frequent calls to emergency ambulance services (STRETCHED) – oral presentation at British Sociological Association Medical Sociology Conference, 2023.
Cohort identification for observational analysis: initial impressions from the STRETCHED study – oral presentation at HSR UK Annual Conference, 2021.
Co-design of a logic model describing components, mechanisms of change and expected impacts of case management for people who frequently call ambulance services – oral presentation at Health and Care Research Wales Conference, 2020.
STRETCHED STRategies to manage Emergency ambulance Telephone Callers with sustained high needs – an Evaluation using linked Data (London) – oral presentation at Frequent Caller National Network meeting, 2019.
STRETCHED: STRategies to manage Emergency ambulance Telephone Callers with sustained high needs – an Evaluation using linked Data (Nottingham) – oral presentation at Frequent Caller National Network meeting, 2019.
Panel session: Who makes high use of the emergency ambulance services and how are services responding to meet the needs of these patients? – chaired by Helen Snooks at HSR UK Conference, 2020.
Co-design of a logic model describing components, mechanisms of change and expected impacts of case management for people who frequently call ambulance services – poster at 999EMS Research Forum Conference, 2021.
Co-design of a logic model describing components, mechanisms of change and potential impacts of case management for people who frequently call ambulance services – poster at HSR UK Conference, 2020.
Co-design of a logic model describing components, mechanisms of change and potential impacts of case management for people who frequently call ambulance services – poster at PRIME Centre Wales Annual Meeting, 2020.
Pros and cons of using anonymised linked routine data to improve efficiency of randomised controlled trials in healthcare: experience in primary and emergency care – poster at 999EMS Research Forum Conference, 2020.
Strategies to manage emergency ambulance telephone callers with sustained high needs – an evaluation using linked data (STRETCHED) – poster at 999EMS Research Forum Conference, 2019.
What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom – poster at HSR UK Conference, 2020.
What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom – poster at 999EMS Research Forum Conference, 2020.
Seminars and workshops
Conference attendance and networking (Manchester) – HSR UK Conference, 2019.
Seminar attendance and networking (Manchester) – HSR UK Spring Seminar, 2019.
Stakeholder event (Bristol) – To develop logic model for case management, 2019.
Training course for paramedics (Swansea) – Research paramedic training, 2019.
Disclaimers
This article presents independent research funded by the National Institute for Health and Care Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.