Evaluation of evidence-based primary care guidelines aiming to reduce emergency admissions in four defined patient/demographic groups

Principal Investigator: Glenda Augustine

Other Key Staff: Prof. Richard Baker, Dr Peter Marks, Dr Paul Sinfield, Dr Simon Baines, Dr Graham Martin, Dr Julian Mallinson, Lorraine Pollard, Dr Nick Willmott

Pertners Involved: NHS Leicestershire County and Rutland

Summary:
Long-term conditions such as Chronic Obstructive Pulmonary Disease (COPD) and heart failure (HF) account for a significant number of emergency hospital admissions and a disproportionate number of readmissions of the same patient.  Additionally, end of life care (ELC) accounts for a substantial proportion (20%) of hospital bed days and emergency admissions in LCR in the chronic frail elderly (CFE) demographic totalled more than 5000 in 2009/10.  Consequently, these four patient/demographic groups (COPD, HF, ELC and CFE) are a major burden on healthcare facilities in NHS LCR and offer an opportunity for a reduction in healthcare costs through optimal clinical management in primary care.

It is believed that targeting at-risk groups of patients in the primary care setting may help to reduce acute admissions, which will benefit not only the patients themselves but also NHS LCR.  A set of disease and patient/demographic-specific guidelines for practitioners within primary care were developed as part of collaboration between the Public Health Department at NHS LCR, the Division of Primary Care, Department of Health Science at the University of Leicester, general practitioners; secondary care clinicians and medicines management colleagues.  These guidelines were presented to local general practitioner groups at seven locality meetings around NHS LCR to promote discussion of the relevance of the guidelines and barriers to their implementation in primary care.  This study aims to evaluate how useful general practitioners found this delivery approach, how effective this targeted approach to reducing acute admissions is likely to be, and how practical the guidelines might be to implement.

Aims:

• To evaluate the content, rationale and mode of delivery of a set of guidelines in primary care targeted at reducing emergency admissions in four distinct patient/demographic groups. 

Further Information:
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Start Date: 01/2011                                                                                         Expected End Date: 07/2011

Project Outcomes:
The primary output of the study will be evidence for LCR on the perceived utility of the guidelines, information that will help LCR judge the likely benefit of the scheme. The question is whether more time or effort should be devoted to this initiative. If the findings of the study do suggest the guideline initiative is beneficial, consideration will be given to disseminating information about the scheme to other PCTs, in particular Leicester City and Northamptonshire. In this case, it may also be appropriate to seek funding to conduct further evaluation.