Sharlene Ting

Nurse-led case management for community dwelling older people : An explorative study of models and costs

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.

A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial

BackgroundParkinsons Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinsons disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinsons is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life.MethodsA pragmatic three parallel group randomised controlled trial involving people with Parkinsons Disease and live-in carers (family friends or paid carers), and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A); multidisciplinary team management and additional support for four months from a trained care assistant (Group B); usual care, no coordinated team care planning or ongoing support (Group C). Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients) and strain (carers). Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants), service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial.DiscussionThe trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinsons Disease in particular, and will provide guidance to inform local service planning and commissioning.Trial registrationISRCTN: ISRCTN44577970

Disease-specific training in Parkinson’s disease for care assistants: a comparison of interactive and self-study methods

Objective: To compare two approaches to providing training to care assistants in Parkinson’s disease. Design: Pragmatic parallel arm controlled trial. Setting: Training either by an interactive training day at a local medical education establishment or self study. Subjects: Care assistants recruited from local health and social care providers. Interventions: The content of both interventions was similar, covering causes, symptoms, diagnosis of Parkinson’s disease, multidisciplinary management, mobility, communication, swallowing, and involving 5 hours of study time. Main measures: Knowledge about Parkinson’s (assessed by true/false quizzes and identifying ‘four facts’ about Parkinson’s) immediately post training and six weeks later; views on training methods of care assistants and employers/managers. Results: Thirty-seven employers nominated 100 care staff who were allocated to interactive training (49) and self study (51). Training completion rates (retained to six-week follow-up) were lower for self study (42.1% vs. 83.7% training day). There were no significant differences between groups on quiz or ‘four facts’ scores at baseline or six-week follow-up. Immediately post training, the self-study group (with access to written materials) had significantly higher quiz scores than the training day group (no access to materials at test). Within-group comparisons showed improvements post training. Although interactive training may be preferred, obtaining release from duties can be problematic. Conclusions: Both approaches have similar effects on knowledge of care assistants without prior specific training. Providing a variety of approaches will cater for all preferences. The findings may be generalizable to training the care workforce for other specific roles.

Nurse-led case management for community dwelling older people: an explorative study of models and costs: Nurse-led case management

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.

Nurse-led case management for community dwelling older people

AIM   To compare community matrons with other nurses carrying out case management for impact on service use and costs. BACKGROUND   In England, nurses working in general practice, as district nurses and disease-specific nurses, undertake use case management. Community matrons were introduced to case management to reduce unplanned hospitalizations of people with complex conditions. METHODS   Managers in three Primary Care Trusts (PCTs) identified four nurses/matrons engaged in case management. Nurses/matrons recruited five community-dwelling patients referred to them for case management. Patients reported use of health/social services for 9 months, 2008 to 2009. Nurses/matrons completed activity diaries. RESULTS   Service use data were available for 33 patients. Compared with other nurse case managers, community matrons had: smaller caseloads; more patient contact time (mean 364 vs. 80 minutes per patient per month); and older patients (mean age 81 vs. 75 years, P = 0.03) taking more medications (mean 8.9 vs. 5.6, P = 0.014). Monthly costs were significantly higher for patients managed by community matrons (add £861), and who lived alone (add £696). Hospitalizations were not associated with patient or service delivery factors. CONCLUSION   Further research on cost-effectiveness of case management models is required. IMPLICATIONS FOR NURSING MANAGEMENT   The case for continued investment in community matrons remains to be proven.