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Research project: The HealthLines Study: expanding the role of NHS Direct in the management of long-term conditions

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As the population is getting older, more and more people are living with long term conditions (LTCs) such as asthma, diabetes and depression. The number of people affected is so large, and is increasing, that the NHS needs to explore new ways of working. There is great interest in the potential of ‘telehealth’ (based on technologies such as the internet and the telephone) to improve care for people with LTCs.


Aim: to develop, implement and evaluate new interventions via NHS Direct for patients with long-term conditions (LTCs) and to provide evidence about benefits and costs.
Objectives: to synthesise evidence about telehealth for LTCs in order to maximise the potential of NHS Direct in supporting LTC management; to explore relationships between access to care, need and willingness to use NHS Direct; to develop interventions based on NHS Direct; to determine clinical & cost-effectiveness of LTC management provided by NHS Direct in 2 exemplar conditions of high cardiovascular risk and depression.


Our programme consists of 5 linked activities:

1. Review and synthesis of quantitative and qualitative evidence about telehealth for patients with LTCs, in order to develop a theory about which types of intervention potentially delivered by NHS Direct are most likely to be effective.

2. Qualitative research with patients and health professionals to examine how NHS Direct can best contribute to LTC management

3. Survey of patients with 2 exemplar LTCs (high cardiovascular risk, depression) to explore relationships between access to care, unmet need and willingness to use NHS Direct; specifically types of telehealth most likely to be acceptable to different patient groups

4. Development of interventions for our exemplar LTCs to be offered by NHS Direct which, based on activities 1 to 3 above, are likely to be acceptable, effective and efficient

5. Randomised trial to determine effectiveness of LTC management provided by NHS Direct in 2 exemplar conditions. We will also use qualitative methods to study implementation and conduct economic evaluation to assess cost-effectiveness and model future costs/benefits following national implementation


A partnership of academics and service providers which combines relevant topic specific and methodological expertise. We have successfully collaborated on many previous projects. The research team is supported by an advisory group which includes principal investigators of other relevant ongoing studies.


This programme:

  • provides a summary of evidence for commissioners about how telehealth interventions can improve care of LTCs and a theoretical basis for future development of interventions
  • identifies types of interventions which if delivered by NHS Direct are likely to be acceptable to patients and the groups of patients most likely to need and use them
  • builds on existing telehealth interventions for which there is already proof of concept to develop programmes of care to be delivered by NHS Direct.
  • provides robust evidence about the implementation, costs and benefits of these LTC programmes.

Basing interventions on theory and paying attention to context and implementation means that if successful these and similar interventions for other LTCs can quickly be rolled out via existing NHS Direct infrastructure to benefit large numbers of people by facilitating self-management and improving health outcomes, patient experience and efficiency.

Project team

Ali Rowsell, Research Fellow
Professor Lucy Yardley, Psychology

Project funder

NIHR Applied Programme

Associated research themes

Evidence synthesis; long term conditions (Depression, Cardiovascular disease); telehealth care; NHS Direct

Related research groups

Active Living and Rehabilitation
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