title: The relationship between use of NHS Direct and deprivation in southeast London: an ecological analysis.
abstract: BACKGROUND
  Little is known about the utilization of NHS Direct by disadvantaged groups, in spite of the service aiming to be 'accessible to all'. This study investigates the relationship between use of NHS Direct and deprivation in one predominantly disadvantaged area.
  
  
  METHODS
  Ward-level call rates to NHS Direct South East London over a 6 month period were calculated using postcode data. Jarman and Townsend scores were used as a proxy of deprivation in each ward. We performed negative binomial regression to investigate the relationship between deprivation score and rate of calls to NHS Direct.
  
  
  RESULTS
  There was a significant, non-linear (quadratic) effect of deprivation score on call rates; call rates were lower in both the most affluent and most deprived wards.
  
  
  CONCLUSIONS
  Calls to NHS Direct rise with increasing deprivation until, at extreme levels of deprivation, they subsequently decline. This challenges assumptions that NHS Direct is not utilized in deprived areas.
authors.affiliation: Immediate Access Project, Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, 5 Lambeth Walk, London SE11 6SP. jenni.burt@kcl.ac.uk
authors.forename: Jenni
authors.initials: J
authors.lastname: Burt
authors.forename: Richard
authors.initials: R
authors.lastname: Hooper
authors.forename: Lynda
authors.initials: L
authors.lastname: Jessopp
mesh_terms: D015277:Hotlines / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D009722:Nurse Practitioners; D011203:Poverty; D012923:Social Class; D013222:State Medicine / Q000458:organization & administration*; D017216:Telemedicine / Q000706:statistics & numerical data*; D014504:Urban Health; D035862:Vulnerable Populations