Complements or substitutes? Associations between volumes of care provided in the community and hospitals

Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

Evaluation of the Manchester COVID-19 Urgent Eyecare Service (CUES)

Introduction Pressure on capacity in ophthalmology alongside the coronavirus (COVID-19) pandemic led to the development of the COVID-19 Urgent Eyecare Service (CUES), allowing patients to receive a prompt ophthalmic consultation, including remotely. The aim of this study was to conduct a service evaluation of CUES in Manchester. Methods Data were collected both prospectively and retrospectively from both primary and secondary care over an 8-week period from June to August 2020. Results In primary care CUES in Greater Manchester (GM) 2461 patients were assessed, with a majority self-referring to the service (68.7%, n = 1844). 91.7% of cases initially screened for CUES were deemed eligible and given a telemedicine appointment in GM; 53.3% of these cases required face-to-face consultation. 14.3% of cases seen within in GM CUES (351 out of 2461) were provisionally referred to secondary care. Contemporaneously the main provider emergency eyecare department (EED) attendances were reduced by 37.7% per month between April and December 2020 inclusive, compared to the same months in 2019. Patients attending a CUES face-to-face assessment were more likely to have a diagnosis in agreement with secondary care, compared to patients referred in from telemedicine assessment only (P < 0.05). Conclusion This evaluation of CUES demonstrates a high level of primary care activity alongside a sustained reduction in EED cases. The case-mix of patients seen within EED following referral appears to be of a less benign nature than those cases seen prior to the introduction of CUES.

A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion

Introduction In Queensland, Australia, the public hospital system has used telehealth for almost three decades. Although telehealth activity has been growing consistently, there are substantial variations across geographic regions. We explored factors which contribute to this variation in telehealth adoption. Methods This was a multi-method comparative study of two matched metropolitan health services and two matched rural health services. The health services were matched according to the number of providers and hospitals but had different rates of telehealth use. Comparative rates of telehealth visits were analysed using descriptive statistics. Qualitative data was obtained from 63 semi-structured interviews with telehealth administrators, clinicians and senior managers involved in telehealth policies and procedures. Data were analysed using a framework analysis. Results The metropolitan health service that had more telehealth use had greater investment in telehealth, higher population referral areas, highly developed communication strategies and understanding of the value proposition for telehealth, and reported fewer information technology and administration systems difficulties. In rural health services, telehealth activity was influenced by onboarding processes, clinician willingness to practice, strategic challenges and primary care activity. Discussion Telehealth adoption can be influenced by funding, cross-organisational strategic policies and a multi-faceted approach to address clinician reluctance to use telehealth.

Evaluating the impact of ‘Be Clear on Cancer’ awareness campaigns on GP attendances

BackgroundThe ‘Be Clear on Cancer’ awareness campaigns aim to raise awareness of cancer symptoms and encourage people with these symptoms to ‘tell their doctor’. GP attendances are therefore a key metric for evaluating the impact of a campaign. We considered the impact on GP attendances of several campaigns since 2013, including the 2015 national oesophagogastric cancer campaign, the 2016 national respiratory symptoms campaign and campaigns for lung cancer, ‘blood in pee’, and breast cancer in women aged >70 years.AimTo consider the impact on GP attendances of several campaigns since 2013, including the 2015 national oesophagogastric cancer campaign, the 2016 national respiratory symptoms campaign and others.MethodData on the weekly numbers of GP attendances and practices were extracted from The Health Improvement Network (THIN) database. For patients reporting campaign symptoms or a control symptom (back pain), the average number of GP attendances per practice per week was calculated. Analysis considered the trend in GP attendances, calculated the change in attendances for the campaign period compared to the same period in an earlier year, and assessed this change using a χ2 test.ResultsThe 2015 oesophagogastric cancer campaign, resulted in a statistically significant 29% increase (P<0.001) in the number of attendances for symptoms of dyspepsia and dysphagia, compared with the same period in 2013. Conversely, there was no significant change in attendances for back pain. Results for other campaigns will be presented.ConclusionThe THIN database has provided primary care data which can be used to assess the impact of awareness campaigns on primary care activity. Results demonstrate increases in GP attendances following some of the campaigns, suggesting that some patients responded to the campaigns’ call to action.

Perceived Barriers, Benefits, and Motives for Physical Activity: Two Primary-Care Physical Activity Prescription Programs

This study examined whether perceived barriers, benefits, and motives for physical activity differed based on allocation to 2 different types of primary-care activity-prescription programs (pedometer-based vs. time-based Green Prescription). Eighty participants from the Healthy Steps study completed a questionnaire that assessed their perceived barriers, benefits, and motives for physical activity. Factor analysis was carried out to identify common themes of barriers, benefits, and motives for physical activity. Factor scores were then used to explore between-groups differences for perceived barriers, benefits, and motives based on group allocation and demographic variables. No significant differences were found in factor scores based on allocation. Demographic variables relating to the existence of chronic health conditions, weight status, and older age were found to significantly influence perceived barriers, benefits, and motives for physical activity. Findings suggest that the addition of a pedometer to the standard Green Prescription does not appear to increase perceived motives or benefits or decrease perceived barriers for physical activity in low-active older adults.