Table 3.

Balance sheet of quantitative and qualitative advantages and disadvantages of the duel intervention to improve self-referral following hypoglycaemic emergency

Advantages	Disadvantages	Comments
Patients’ experience
Prompt card
The prompt card was perceived to be highly acceptable, and respondents indicated that it had prompted them follow-up their care:- ➢ 67 % said that they were left the prompt card. ➢ 63 % found the card to be ‘useful to extremely useful’. ➢ 96 % who received the prompt card said it was ‘useful to  extremely useful’. ➢ 38 % who were left the prompt card, said that it encouraged  them to follow-up their care. ➢ 42 % who were left the prompt card said that the verbal advice  encouraged their follow-up care. ➢ There was a 2–3 fold increase in self-reported self-referral to  diabetic care providers following receipt of prompt card.	➢ The ‘full’ intervention (prompt card + NHS24 phone call) was  reported as being delivered 36 % of the time. ➢ There was no evidence from linked data analysis, or participant  reports, that the intervention had any significant effect on  increasing the proportion of patients who attend their usual  diabetes care provider for follow up for a review of their  medication and other risk factors following a hypoglycaemic  emergency attended by the ambulance service.
Telephone call
NHS24 attempted to contact all patients. ➢ 75 % of all calls made were answered. ➢ 40 % of patients were contacted on the first call ➢ 69 % of answered calls were directly with the patient, 13 %  were with close relatives. ➢ 67 % of respondents found the follow-up phone-call “useful- extremely useful”. ➢ 63 % of individuals found the card to be ‘useful to extremely  useful’.	➢ Of the calls that were answered 12 % of answered calls were  third party individuals’ with no knowledge of the patient. ➢ A few participants (n = 6) stated they would not follow-up  their care when contacted by NHS24.	Third party call recipients are likely to have been at locations that were not a patient’s home (e.g. a supermarket). The ambulance service records the telephone number of the call, not patients’ home or mobile number. Despite very positive comments about the card many did not appear to follow-up up their care.
Ambulance clinicians experience (44 % [n = 92) completed the questionnaire, 91 % had attended a hypoglycaemic emergency during the study period).
Pros	Cons	Comments
➢ All respondents rated the prompt card & telephone follow- up ‘very - highly useful’ ➢ 83 % felt the location of the prompt card in the response  bag made them easier to access and 77 % felt this increased  the likelihood that they would pass the prompt card onto  patients. ➢ 69 % said they always left the prompt card. 13 % said the  usually left the prompt card ➢ 62 % suggested they always or usually left the prompt card  sticker. ➢ 96 % were aware that the patient would receive a follow- up telephone call. ➢ 73 % said they always told the patient to expect a follow- up telephone call.	➢ Prompt cards were reported as declined by patients or carers  on 4 occasions. ➢ Prompt cards were forgotten to be left on 8 occasions ➢ Prompt cards were not available on 6 occasions. ➢ 38 % said they ‘sometimes’ or ‘never’ used it ➢ 11 % said they ‘sometimes’ or ‘never’ told the patient to  expect a follow-up telephone call.	The intervention was generally perceived to be very acceptable and feasible in practice.