LONG-TERM CONDITIONS Pilot sites plan to extend US care model

Published: 07/04/2005, Volume II5, No. 5949 Page 9

A major report into progress at nine Evercare pilot sites in the NHS has found widespread satisfaction with the model but does not produce evidence either of reduced admissions or cost-effectiveness.

Despite the lack of hard data all the primary care trusts involved plan to extend the scheme, more than tripling the number of advanced primary nurses employed to manage the care of patients with long-term conditions at home.

The report involved surveys of patients, nurses and GPs by Picker Institute Europe as well as interviews with PCT managers conducted by Evercare staff. In addition, anonymised patient data from all nine pilot projects was analysed by Evercare and the PCTs involved.

Altogether 30 advanced primary nurses have recorded 18,073 contacts with 1,333 patients who spent an average of eight months in the programme.

The number of advanced primary nurses is expected to rise to at least 94 in 2005, executives at the nine PCTs revealed.

Of 1,218 patients and carers surveyed, nearly two-thirds said overall care was better, while two-fifths said care was a lot better.

Of the 182 GPs surveyed, fourfifths said the advanced practice nurse helped deliver more holistic, patient-centred care and reduced their workload. Data analysis showed that patients who were referred because of previous unplanned admissions consulted their doctor less often, and required fewer home visits and outpatient appointments.

However, key data on reducing unplanned admissions and costeffectiveness is not included.

The report says that, although it was possible to track a reduction in the number of unplanned admissions for patients, it was impossible to extract how much of this was due to Evercare's intervention.

The NHS and social services in England are expected to reduce inpatient emergency bed days by 5 per cent by March 2008 using 200304 as the baseline.

The report also calls for better community infrastructure, such as intermediate care facilities and community-based diagnosis, to provide alternatives to admission.

Dr Richard Smith, chief executive of UnitedHealth Europe, which has been contracted to pilot Evercare in England, said: 'It is important that PCTs understand that case management is not going to be enough to reduce hospital admissions. You need a multi-pronged approach.'