The Pharmaceutical Journal
Vol 277 No 7427 p597
18 November 2006

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Community matrons “will not reduce admissions”

Community matrons are unlikely to reduce hospital admissions, but will be popular with patients, a review of similar case management systems published on BMJ Online First concludes (15 November 2006).

The review examined Evercare pilots in nine primary care trusts in England that, between 2003 and 2005, introduced case management of elderly people believed to be at high risk of emergency admission.

The authors say that the introduction of case management for frail elderly people provided an additional range of services in primary care and that the pilots have suggested ways to improve methods for identifying high-risk groups. However, their qualitative analysis found that case management had no significant impact on rates of emergency admission — one of the key aims of the programme — or on emergency bed days or mortality.

“We predict the same outcome from the newly introduced community matron policy, as the community matron model is based on the same principles as Evercare advanced primary nurses,” the researchers say.

The authors recognise, however, that their study had relatively low power to detect changes in outcomes and did not collect data on any direct measures of the health of the target population.

Alaster Rutherford, head of medicines management at Bristol Primary Care Trust, was involved with the Evercare pilot in Bristol. He told The Journal that one early lesson from Evercare was that data, in practices, PCTs and acute trusts, were not reliable. “It may well be that this research, which does have some serious methodological weaknesses, reflects that and there is now more effective targeting of patients needing enhanced care,” he said.

“For example, the assumption at the time was that recurrent admission patients were the priority, whereas far more sophisticated risk stratification tools are now available,” he added. “Also, experience has shown that whole-systems reforms need to accompany this case management approach and pharmacy has a big role to play in these reforms — changes which were not fully developed at the early stage this research was conducted.”

Pharmacy has a significant role to play in preventing admissions and, more specifically, improving patients’ outcomes outside hospital, he argued. “In Bristol, pharmacy was heavily involved in supporting Evercare from the outset, from identifying ‘high-risk’ patients, to extending the range of drugs which could be accessed quickly for patients in their own homes.”