INFORM: Improving care for people who Frequently call 999: co-production of guidance through an Observational study using Routine linked data and Mixed methods


Ashra Khanom - a.khanom@swansea.ac.uk

Principal / Lead Investigator

Ashra Khanom


Alison Porter (Academic mentor), Helen Snooks (Academic mentor)

Type of study



People who frequently call the 999-ambulance service present a challenge to the ambulance service and their needs are inadequately met. I aim to understand patterns of service use and health outcomes of callers in this mixed methods study.

Firstly, I will carry out a scoping review of literature. Patient health outcomes will be explored through anonymised linked data and I will examine the views of stakeholders, who will include patients, health practitioners and third sector providers. I will do this using qualitative Bio-photographic interview method (with patients) and focus groups with (service providers). All information collected from this study will be used to work with stakeholders to co-produce a ‘Guidance of Care’ for use by the ambulance service to be evaluated in a later study.

Public & patient involvement

I have worked extensively with our two Patient and Public Involvement (PPI) representatives as equal members of our team. They have been involved with the study from pre-submission stage, actively contributing to discussions on research design and have commented on written drafts of the bid, in terms of both content and presentation; for instance, highlighting the difficult nature of terminology that is used by services and other stakeholders to describe the target population. We have responded to this by explicitly adding exploration of this issue within the qualitative data. 

Both PPI members have agreed to provide advice and support to deliver key elements of the study such as the scoping review, patient recruitment, data analysis, patient information leaflets and consent forms and co-production workshops.

Who is the study sponsor?

Swansea University

How could this research potentially benefit patients?

The study will benefit patients by addressing a significant gap in knowledge and understanding relating to people who call 999 frequently. This research will provide a sound evidence based footing from which to design future potential intervention measures ‘from the ground up’.

Moreover, by engaging extensively with patients and other stakeholders; taking their perspectives into account to fully understand the nature of the problem, this study will represent a crucial first step in embedding co-production into the development of future interventions.

Within this study, co-production will be used to develop guidance for ambulance services with the aim of improving patient health outcomes. Potentially, the guidance can help to reduce frequent calling (benefit for WAST); improve patient experience and outcomes (benefit for patients); identify opportunities for improvements to health and social care provision more widely (benefit for system).


Health and Care Research Wales Fellowships

Total grant value

£ 300,409

Start date


End date


Further information 

To follow

Outputs generated (Reports / Publications / Impact)