Social Care Resource Research Articles

A redesign of hospice social care services

IntroductionThe social care resource of the typical hospice has developed in steps over a period of time, as and when funding becomes available. As a consequence of this the structures...

Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS)

BackgroundMany older people presenting to Acute Medical Units (AMU) are discharged after only a short stay (< 72 hours), yet many re-present to hospital or die within 1 year. Comprehensive Geriatric Assessment may improve patient outcomes for this group.MethodParticipantsPatients aged > 70 years and scoring positive on a risk screening tool ('Identification of Seniors At Risk') who are discharged within 72 hours of attending an AMU with a medical crisis, recruited prior to discharge. Sample size is 400. Carers of participants will also be recruited.InterventionAssessment on the AMU and further out-patient management by a specialist physician in geriatric medicine. Assessment and further management will follow the principles of Comprehensive Geriatric Assessment, providing advice and support to primary care services.DesignMulti-centre, individual patient randomised controlled trial comparing intervention with usual care.Outcome measurementFollow up is by postal questionnaire 90 days after randomisation, and data will be entered into the study database by a researcher blind to allocation. The primary outcome is the number of days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, health and social care resource use, and scaled outcome measures, including quality of life, disability, mental well-being. Carer strain and well being will also be measured at 90 days.AnalysesComparisons of outcomes and costs, and a cost utility analysis between the intervention and control groups will be carried out.Trial RegistrationISRCTN: ISRCTN21800480

Prevalence of diabetic macular oedema and related health and social care resource use in England

AimsTo address the absence from the public health ophthalmology literature of age- and sex-specific prevalence and related resource use for diabetic macular oedema (DMO) in England, UK.MethodsCalculation of age- and...

Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use and cost study

national policy recommends routine re-assessment of disabled patients and their carers at 6 months after stroke onset. The clinical and resource outcomes of this policy were investigated. prospective, single-blind, randomised controlled trial in two centres. a total of 265 patients with a disabling stroke and their carers. a structured re-assessment system for patients and their carers at 6 months post-stroke or existing care. primary: patient independence (Frenchay activities index) and carer stress (general health questionnaire 28). Secondary: activities of daily living, mood state, satisfaction with services, carer strain index, health and social service resource use and costs. independence at 12 months post-stroke was similar in both groups (Frenchay activities index, adjusted mean difference 0.64; 95% confidence interval -0.74-2.02). Emotional distress in carers was similar in both groups (general health questionnaire 28, mean difference 0.02; 95% confidence interval -0.95-1.00). Results for the secondary outcome measures and total mean costs were similar for both groups. The intervention group patients used 301 fewer hospital bed days and 1,631 fewer care home bed days. the structured, systematic re-assessment for patients and their carers was not associated with any clinically significant evidence of benefit at 12 months. Health and social care resource use and mean cost per patient were broadly similar in both groups. International Standard Randomised Controlled Trial Register; number: ISRCTN55412871.

Economic costs of post-natal depression in a high-risk British cohort.

Post-natal depression is a common condition that can result in distress for the mother and deleterious effects on the development of the infant. To estimate the economic costs of post-natal depression in a geographically defined cohort of women at high risk of developing the condition. Unit costs were applied to estimates of health and social care resource use made by 206 women recruited from antenatal clinics and their infants. Net costs per mother-infant dyad over the first 18 months post-partum were estimated. Mean mother-infant dyad costs were estimated at pound 2419.00 for women with post-natal depression and pound 2026.90 for women without post-natal depression, a mean cost difference of pound 392.10 (P=0.17). The mean cost differences between women with and without post-natal depression reached statistical significance for community care services (P=0.01), but not for other categories of service. Economic costs were higher for women with extended experiences of the condition. The results of this study should be used to facilitate the effective planning of services by different agencies.