Intermediate Care: Lessons from a Demonstrator Project in Fife

Mitchell, Fraser; Dobson, Claire; McAlpine, Anne; Dumbreck, Siobhan; Wright, Ian; Mackenzie, Fiona

doi:10.5042/jic.2011.0033

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…Service users who feel they have been ‘let down’ by promises of health and social care provision in the past are likely to be reluctant to take‐up what they perceive to be similarly weak services (Petch ). It seems to be essential to address this perceived risk about home ESD services, where service users have previously had negative experiences, as it constitutes a substantial risk to the feeling of safety in one's home that is valued so highly (Mitchell ). Collaborative decisions about care and place of care can therefore only be made where service users feel confident in service standards.…”

Section: Synthesismentioning

confidence: 99%

Providing effective and preferred care closer to home: a realist review of intermediate care

Pearson

Hunt

Cooper

et al. 2015

Health Soc Care Community

101

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Intermediate care is one of the number of service delivery models intended to integrate care and provide enhanced health and social care services closer to home, especially to reduce reliance on acute care hospital beds. In order for health and social care practitioners, service managers and commissioners to make informed decisions, it is vital to understand how to implement the admission avoidance and early supported discharge components of intermediate care within the context of local care systems. This paper reports the findings of a theory‐driven (realist) review conducted in 2011–2012. A broad range of evidence contained in 193 sources was used to construct a conceptual framework for intermediate care. This framework forms the basis for exploring factors at service user, professional and organisational levels that should be considered when designing and delivering intermediate care services within a particular local context. Our synthesis found that involving service users and their carers in collaborative decision‐making about the objectives of care and the place of care is central to achieving the aims of intermediate care. This pivotal involvement of the service user relies on practitioners, service managers and commissioners being aware of the impact that organisational structures at the local level can have on enabling or inhibiting collaborative decision‐making and care co‐ordination. Through all interactions with service users and their care networks, health and social care professionals should establish the meaning which alternative care environments have for different service users. Doing so means decisions about the best place of care will be better informed and gives service users choice. This in turn is likely to support psychological and social stability, and the attainment of functional goals. At an organisational level, integrated working can facilitate the delivery of intermediate care, but there is not a straightforward relationship between integrated organisational processes and integrated professional practice.

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Section: Synthesismentioning

confidence: 99%

Providing effective and preferred care closer to home: a realist review of intermediate care

Pearson

Hunt

Cooper

et al. 2015

Health Soc Care Community

101

View full text Add to dashboard Cite

show abstract

“…This enhancement showed promising results, but interpretation was difficult as rates were not reported and the data was incomplete [ 58 ]. Our study did not directly assess the potential benefit of including a pharmacist in IC, however a pilot study in Fife, Scotland described a number of positive outcomes for patients although the study methodology was weak [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of ‘Enhanced’ Intermediate Care Integrating Acute, Primary and Community Care and the Voluntary Sector in Torbay and South Devon, UK

Elston

Gradinger

Asthana

et al. 2022

International Journal of Integrated Care

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Introduction: Intermediate care (IC) was redesigned to manage more complex, older patients in the community, avoid admissions and facilitate earlier hospital discharge. The service was ‘enhanced’ by employing GPs, pharmacists and the voluntary sector to be part of a daily interdisciplinary team meeting, working alongside social workers and community staff (the traditional model). Methods: A controlled before-and-after study, using mixed methods and a nested case study. Enhanced IC in one locality (Coastal) is compared with four other localities where IC was not enhanced until the following year (controls), using system-wide performance data (N = 4,048) together with ad hoc data collected on referral-type, staff inputs and patient experience (N = 72). Results: Coastal showed statistically significant increase in EIC referrals to 11.6% (95%CI: 10.8%–12.4%), with a growing proportion from GPs (2.9%, 95%CI: 2.5%–3.3%); more people being cared for at home (10.5%, 95%CI: 9.8%–11.2%), shorter episode lengths (9.0 days, CI 95%: 7.6–10.4 days) and lower bed-day rates in ≥70 year-olds (0.17, 95%CI: 0.179–0.161). The nested case study showed medical, pharmacist and voluntary sector input into cases, a more holistic, coordinated service focused on patient priorities and reduced acute hospital admissions (5.5%). Discussion and conclusion: Enhancing IC through greater acute, primary care and voluntary sector integration can lead to more complex, older patients being managed in the community, with modest impacts on service efficiency, system activity, and notional costs off-set by perceived benefits.

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Intermediate Care: Lessons from a Demonstrator Project in Fife

Cited by 2 publications

References 16 publications

Providing effective and preferred care closer to home: a realist review of intermediate care

Providing effective and preferred care closer to home: a realist review of intermediate care

Impact of ‘Enhanced’ Intermediate Care Integrating Acute, Primary and Community Care and the Voluntary Sector in Torbay and South Devon, UK

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