Dr Vanessa Botan, research associate in statistics at CaHRU, gave an oral presentation of the NIHR Applied Research Collaboration East Midlands funded study, on ‘The effects of a leaflet-based intervention, ‘Hypos can strike twice’, on recurrent hypoglycaemic attendances by ambulance services (Ambu-HS2)‘ at the 999 EMS Research Forum Conference 2021. The conference ‘Research in prehospital care: Past, pandemic, present & future’ took place online on Tuesday 23 March 2021. The Ambu-HS2 study team, led by Professor Niro Siriwardena, included Professor Graham Law, Dr Murray Smith, Dr Colin Ridyard and Despina Laparidou at CaHRU, members of the Healthier Ageing PPI group (Mrs Amanda Brewster, Pauline Mountain and Keith Spurr), colleagues at the University of Leicester (Mrs June James and Prof Kamlesh Khunti) and East Midlands Ambulance Service NHS Trust (Sally Dunmore and Rob Spaight).
The study aimed to investigate the effect of an intervention in which ambulance clinicians provided advice, supported by the ‘Hypos can strike twice’ booklet, following a hypoglycaemic event to prevent future attendances. The study 
used a non-randomised stepped wedge-controlled design, where the intervention was introduced at different times (steps) in different areas (clusters) in EMAS. The study included 4825 patients experiencing hypoglycaemic events attended by EMAS. Analysis using a generalised linear mixed model showed a reduction in the number of unsuccessful attendances (i.e. attendance followed by a repeat attendance) in the final step of the intervention when compared to the first (OR: 0.50, 95%CI: 0.33-0.76, p=0.001). This was supported by an interrupted time series analysis which showed a significant decrease in repeat ambulance attendances for hypoglycaemia relative to the pre-intervention trend (p=0.008). The quality of care, as measured by a hypoglycaemia care bundle increased significantly to 66% of attendances (p<0.001) during the intervention period.
The ‘Hypos can strike twice’ intervention had a positive effect on reducing numbers of repeat attendances for 
hypoglycaemia and in achieving the hypoglycaemia care bundle. The study supports the wider use of this intervention to prevent future attendances for recurrent hypoglycaemic events. The study was funded by NIHR Applied Research Collaboration, but study design and analysis were carried out independently of the funder who had no role in the conduct or analysis of the research or preparation of the manuscript. To see the presentation click here.
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