A case-management intervention designed to reduced emergency department (ED) admissions did ‘not create additional workload in primary care’, a study has found.
The study looked at the impact of a telephone-based case-management health coaching intervention, which gave regular 15-minute telephone calls to patients from a health coach over a six-month period.
Within this coaching intervention, a personalised care plan was developed alongside motivational conversations, support for self-care, patient education and coordination of social and medical services. However, no medical advice or treatment was delivered.
The study, published in the BJGP, found that the intervention did not increase workload for primary care.
It also found there was a decrease in secondary care referrals, which the authors suggested could reduce secondary care workload.
The authors said: ‘This may be due to patients having their conditions managed effectively in the community, supported by health coaches, without the need for onward referral, thereby freeing capacity in secondary care.’
The authors said the BJGP study could be used to help focus services for those with greater clinical need.
Assessing demands on primary care
Case-management strategies – the process of planning and facilitating options to meet a patient’s health needs – can lead to a 12-26% reduction in emergency admissions, when targeted to frequent ED attenders, the authors said.
However, prior to the study, its authors were concerned that ‘any diversion of patient care from ED may increase demands on primary care’ which is ‘itself a system under increasing strain’.
To assess this impact, researchers placed 253 patients at high-risk of ED in a 6-month case-management intervention programme, while 110 continued to receive standard care, which included social prescribing and community services delivered by primary care and the local community trust.
They found that, between the two groups, there was ‘no significant difference’ in the annual rate of primary care appointments.
This is despite the intervention offering patients an initial face-to-face meeting to discuss the plan, followed by regular 15-minute phone appointments with a health navigator over six months, with a care plan focusing on self-care and education.
Among those who were part of the programme, the number of face-to-face consultations also dropped from a monthly rate of three to 1.6 over two years.
Telephone consultations similarly dropped from 0.8 per month to 0.5 over the same period.
However, there was a 33% increase in primary care contact among patients over 80: the age group which most people with complex medical needs fall into.
But the authors suggested that the reduction among under-80s – where the collective burden of chronic disease is lower – may indicate the intervention supports patients without the need for their GP’s involvement.
The authors suggested the model could be scaled up without the need of a large workforce given that high-risk patients for unplanned care are a small proportion of all patients.
This study comes after the BMA warned that practices are currently offering more appointments ‘than they can safely accommodate’.
