Chronic disease programme needs more work, says think tank
pharmafile | February 14, 2005 | News story | |
The new system of chronic disease management currently being piloted in ten PCTs needs further evaluation before it is extended across England, a leading think tank has warned.
The King's Fund says an independent evaluation of the ten pilot projects carried out by Manchester University has revealed that the 50% reduction in emergency admissions to hospital seen in the US has not materialised in the UK – where admissions have fallen by just an estimated 1%.
The system uses specially trained nurses to monitor at-risk patients at home, and despite uncertainty about its clinical effectiveness, the scheme is popular with patients and healthcare professionals.
King's Fund director of health policy Jennifer Dixon said: "This is not the green light that ministers were hoping for. Case management programmes like Evercare have the potential to improve the quality of life for these patients. But the results show that before this approach is implemented any further in England, or procured by the NHS from the private sector, a system of robust evaluation should be set up by the Department of Health to examine the cost-effectiveness of different approaches."
Dixon speculated that the UK pilots may not have seen the expected reduction in admissions because the methods for selecting patients for case management had failed to identify those at highest risk, or because the type of case management used was not effective.
"We should learn from these pilots, and try different forms in the future. These interim results for Evercare show there is still a lot to learn and evidence about which type of programme is the most effective is still limited."
In January the government unveiled plans for the creation of 3,000 new 'community nurses' by 2007 who will co-ordinate chronic disease management across the NHS and contribute to a targeted 5% reduction in beds used over the next three years.
Just 10% of patients currently account for 55% of stays in hospitals, and many of these patients have several long-term conditions.
The PCTs participating in the scheme are: Airedale, Bexley (care trust) Bristol North, Bristol South and West, Halton, Luton, South Gloucestershire, Walsall and Wandsworth. A tenth PCT, North Tees is looking at data and analysis for more effective commissioning and clinical governance.
