Integrated specialist assessment of older people and predictors of care-home admission

Clarkson, Paul; Venables, Dan; Hughes, Jane; Burns, Alistair; Challis, David

doi:10.1017/s0033291706007434

Cited by 15 publications

(16 citation statements)

References 33 publications

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“…12,17,22,51,53,56,57,91 In the studies that showed a decrease in institutionalization, 48,64,67 the mean effect size was small (0.21). 48,67 In 2 of 5 studies, hospital admission decreased (mean effect size = 0.66).…”

Section: Description Of the Case Management Interventionsmentioning

confidence: 95%

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Khanassov

Vedel

Pluye

2014

The Annals of Family Medicine

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PURPOSE Results of case management designed for patients with dementia and their caregivers in community-based primary health care (CBPHC) were inconsistent. Our objective was to identify the relationships between key outcomes of case management and barriers to implementation. METHODSWe conducted a systematic mixed studies review (including quantitative and qualitative studies). Literature search was performed in MEDLINE, PsycINFO, Embase, and Cochrane Library (1995 up to August 2012). Case management intervention studies were used to assess clinical outcomes for patients, service use, caregiver outcomes, satisfaction, and cost-effectiveness. Qualitative studies were used to examine barriers to case management implementation. Patterns in the relationships between barriers to implementation and outcomes were identified using the configurational comparative method. The quality of studies was assessed using the Mixed Methods Appraisal Tool.RESULTS Forty-three studies were selected (31 quantitative and 12 qualitative). Case management had a limited positive effect on behavioral symptoms of dementia and length of hospital stay for patients and on burden and depression for informal caregivers. Interventions that addressed a greater number of barriers to implementation resulted in increased number of positive outcomes. Results suggested that highintensity case management was necessary and sufficient to produce positive clinical outcomes for patients and to optimize service use. Effective communication within the CBPHC team was necessary and sufficient for positive outcomes for caregivers.CONCLUSIONS Clinicians and managers who implement case management in CBPHC should take into account high-intensity case management (small caseload, regular proactive patient follow-up, regular contact between case managers and family physicians) and effective communication between case managers and other CBPHC professionals and services.

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Section: Description Of the Case Management Interventionsmentioning

confidence: 95%

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Khanassov

Vedel

Pluye

2014

The Annals of Family Medicine

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“…A full description of the criteria has been published (Challis et al, 2004). The data, on the existence and identification of a range of needs, from before the SAP were available from a randomized trial of assessment practice for older people, the findings of which have already been reported (Challis et al, 2004; Clarkson, Venables, Hughes, Burns, & Challis, 2006; Venables, Clarkson, Hughes, Burns, & Challis, 2006).…”

Section: Participants and Methodsmentioning

confidence: 99%

The identification and detection of dementia and its correlates in a social services setting: Impact of a national policy in England

et al. 2011

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Dementia continues to be under-recognized, an important issue in many countries. Policy addressing this has focused on the role of general practice-based staff, but dementia represents an area in which closer collaboration between community health and social services can reap benefits. This study examined the impact of a national policy in England, the Single Assessment Process (SAP), introduced across these agencies from April 2004, aimed at improving assessments by the use of shared procedures and assessment tools. Impact was measured in terms of the reliability by which dementia, and associated conditions, were identified and correctly detected in one area’s statutory community care assessments. Recognition of dementia, grooming, toileting and incontinence difficulties were significantly improved after the policy. Depression was an exception. Existing communication difficulties made it more likely that dementia would be identified and correctly recognized. Findings are discussed in terms of more closely involving care managers in detecting dementia.

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“…That said, the data from the social services domiciliary sample would seem to suggest that at any one time there are a number of people in the community with considerable ongoing care needs who receive relatively little formal support. In the light of evidence that specialist integrated assessment may potentially defer the care home admission of older people at risk, 174 the fact that more than half of care home entrants had not been seen by specialist mental health services was also noteworthy.…”

Section: Implications For Local Service Providersmentioning

confidence: 99%

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Challis

Tucker

Wilberforce

et al. 2014

Programme Grants for Applied Research

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BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Integrated specialist assessment of older people and predictors of care-home admission

Abstract: In this at-risk group, integrated assessment offers a means of potentially both delaying care-home admissions and taking account of a wider range of factors in placement decisions. Such an approach is viewed as an important policy goal both in the UK and internationally.

Cited by 15 publications

References 33 publications

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

Barriers to Implementation of Case Management for Patients With Dementia: A Systematic Mixed Studies Review

The identification and detection of dementia and its correlates in a social services setting: Impact of a national policy in England

National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

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