scholarly journals Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT

2018 ◽  
Vol 6 (31) ◽  
pp. 1-188 ◽  
Author(s):  
Peter Bower ◽  
David Reeves ◽  
Matt Sutton ◽  
Karina Lovell ◽  
Amy Blakemore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Integrated Care ◽  
Patient Outcomes ◽  
Social Care ◽  
Health Coaching ◽  
Long Term Conditions ◽  
Community Assets ◽  
Health And Social Care

BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.

scholarly journals Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033186 ◽  
Author(s):  
Luke Aaron Munford ◽  
Anna Wilding ◽  
Peter Bower ◽  
Matt Sutton
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Secondary Outcome ◽  
Long Term Conditions ◽  
Community Assets ◽  
Costs Of Care ◽  
Life Years ◽  
Double Robust

ObjectivesImproving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.DesignProspective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.SettingParticipation in community asset facilities. Costs of primary and secondary care.Participants4377 older people with long-term conditions.InterventionParticipation in community assets.Primary and secondary outcome measuresQuality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.ResultsStarting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £−96 (95% CI £−512 to £321) at 6 months; £−283 (95% CI £−926 to £359) at 12 months; and £−453 (95% CI £−1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of −0.102 (95% CI −0.173 to −0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.ConclusionsParticipation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.

Investigating the relative value of health and social care related quality of life using a discrete choice experiment

2019 ◽  
Vol 233 ◽  
pp. 28-37 ◽  
Author(s):  
Brendan Mulhern ◽  
Richard Norman ◽  
Richard De Abreu Lourenco ◽  
Juliette Malley ◽  
Deborah Street ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Social Care ◽  
Relative Value ◽  
Health And Social Care ◽  
Related Quality ◽  
Value Of Health

scholarly journals SOCIAL CARE-RELATED QUALITY OF LIFE IN OLDER PEOPLE WITH MULTIMORBIDITY

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1212-1213
Author(s):  
A. Stoop ◽  
R. Hendrikx ◽  
H. Drewes ◽  
G. Nijpels ◽  
C. Baan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Social Care ◽  
Related Quality

scholarly journals Developing a joint outcomes contracting model for integrated health and social care for older people

2016 ◽  
Vol 24 (5/6) ◽  
pp. 282-299
Author(s):  
Jenny Billings ◽  
Alison Davis
Keyword(s):  
Older People ◽  
Social Care ◽  
Local Development ◽  
Chronically Ill ◽  
Long Term Conditions ◽  
Content Type ◽  
Health And Social Care ◽  
Integrated Health ◽  
Contracting Model ◽  
Whole Systems

Purpose Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. The purpose of this paper is to describe a three-phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long-term conditions, and based on joint outcomes. Design/methodology/approach A participative mixed-method approach for the development of the contracting model was used; this consisted of a literature review, a design phase drawing on consensus method through stakeholder discussions and an international validation phase. Findings The final contracting model consists of four overarching and interrelated core elements: outcomes; partnership, collaboration and leadership; financial: incentives and risk; and legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria. Research limitations/implications While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed. Practical implications The paper concludes with reflections on the way forward for local development and implementation. Originality/value There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focusses on joint outcomes. This research bridges the gap but recognizes the challenges to implementation.

Providing dignified continence care to older people at end of life

2019 ◽  
Vol 25 (10) ◽  
pp. 504-512 ◽  
Author(s):  
Linda Nazarko
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
End Of Life ◽  
Older Person ◽  
Entire Family ◽  
Long Term Conditions ◽  
Age Related ◽  
Age Related Changes

The prevalence of urinary incontinence increases as a person ages, as age-related changes make it more difficult to maintain continence. Long-term conditions and treatments prescribed to treat conditions, such as heart failure, can lead to an urgency to void the bladder. Frailty can make it difficult for an older person to respond this need. At end of life, mobility is often compromised and people can experience extreme fatigue. Caregivers can obtain support to manage an individual's incontinence during the day but often struggle alone at night. Caregivers can become exhausted and a situation can reach breaking point. Working with the older person and caregivers to determine the goals of care and how to meet them can make a huge difference. It can take the pressure off the entire family, meet a person's needs and enable the person to stay at home. This article aims to enable nurses to understand the problems older people may experience and how to work with the older person and caregivers to develop solutions that maintain dignity and enhance quality of life.

scholarly journals Does a social prescribing ‘holistic’ link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation

2019 ◽  
Vol 20 ◽  
Author(s):  
Julian Elston ◽  
Felix Gradinger ◽  
Sheena Asthana ◽  
Caroline Lilley-Woolnough ◽  
Sue Wroe ◽  
...  
Keyword(s):  
Older People ◽  
Service Use ◽  
Social Care ◽  
Patient Activation ◽  
Well Being ◽  
Long Term Conditions ◽  
Social Prescribing ◽  
Health And Social Care ◽  
Before And After ◽  
The Impact

Abstract Aim: To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.

Mental Health and Social Care Providers Facing Requests of Assisted suicide from Elderly in Nursing Homes in Switzerland

2017 ◽  
Vol 41 (S1) ◽  
pp. S11-S12
Author(s):  
D.A. Castelli Dransart ◽  
S. Voélin ◽  
S. Elena
Keyword(s):  
Nursing Homes ◽  
Older People ◽  
Assisted Suicide ◽  
Social Care ◽  
Home Care Services ◽  
Care Providers ◽  
Care Services ◽  
Health And Social Care ◽  
Competing Interest

IntroductionIn some Swiss states, right-to-die associations are allowed to assist older people in nursing homes provided that certain requirements are fulfilled.ObjectivesTo investigate how health and social care providers and their institutions reacted to and dealt with requests of assisted suicide.MethodAn exploratory qualitative study was carried out in the States of Fribourg and Vaud among 40 professionals working in nursing homes, home care services or social welfare agencies.ResultsThe requests of assisted suicide questioned the professional mission, the quality of accompaniment provided to the older people and both professional and personal values. Health and social care providers were required to ponder over ethical dilemmas or decisions. Several challenges were reported, such as: taking into account and articulating personal freedom or needs with collective functioning or organizational constraints before, during and after the assisted suicide; reconciliating self-determination with protection towards vulnerable people (beneficere, non maleficere).ConclusionsAssisted suicide challenges and changes professional end-of-life practices. Education and support should be provided to health and social care providers faced with it.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019296 ◽  
Author(s):  
Helen Elsey ◽  
Tracey Farragher ◽  
Sandy Tubeuf ◽  
Rachel Bragg ◽  
Marjolein Elings ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pilot Study ◽  
Social Care ◽  
Recruitment And Retention ◽  
Health And Social Care ◽  
Probation Service ◽  
Assess Quality ◽  
The Impact

ObjectivesTo assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services.DesignPilot study using questionnaires to assess quality of life, individually linked to police and probation data.SettingThe pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management.ParticipantsWe recruited 134 adults (over 18) serving COs in England, 29% female.Results52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder.ConclusionsRecruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies.

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