03.10.12
Home-based healthcare
Source: Gitali, via www.nationalhealthexecutive.com
Re: ‘Healthcare not just closer to home - but in the home’
www.nationalhealthexecutive.com/Interviews/healthcare-not-just-closer-to-home-but-in-the-home
Before the UK health leadership sleepwalks into yet another ideologically charged non-evidence based ‘project’, let us be also aware of the cost implications of this ‘healthcare at home’ approach (the publication of data against the official dogma is probably a bit easier nowadays than medieval Europe, they are still not the most favourite with journal editors).
Evidence 1: Goossens L et al. ‘Cost-effectiveness of early assisted discharge for COPD exacerbations in the Netherlands’. Paper P1299 presented at the Eurpopean Respiratory Society meeting on Sunday , 02 September 2012 shows that "no clear evidence was found to conclude that either treatment was more effective or less costly" and "After three months follow-up, differences in effectiveness had disappeared. The difference in quality-adjusted life years (QALYs) was 0.0054 (CI: -0.021; 0.0095). Early assisted discharge saved costs from a healthcare perspective, but not significantly: -Eur 168 (CI: -1253; 922).
From a societal perspective, total costs increased, due to higher informal care costs: Eur 908 (CI: -553; 2296)."
With the efficiency savings and cuts in the social services, the possibility of delivering healthcare at home in the UK seems an untenable option given that social expenditure increased by nearly 3 times with this "lovely" idea of healthcare at home.
Evidence 2: Dalay S et al. "Efficacy and safety of applying the British Thoracic Society (BTS) criteria to determine appropriateness of follow up in general respiratory clinics" Paper P1303 presented at the Eurpopean Respiratory Society meeting on Sunday , 02 September 2012 [http://www.ers-education.org/pages/default.aspx?id=2828&idBrowse=119853&det=1] showed that the future of sustainable Long Term Condition management is specialist-led integrated care.
It also showed that "Patient-focussed, multidisciplinary approach to long-term respiratory conditions allows accurate diagnosis and appropriate discharge planning to take place using the BTS criteria". It is high time that the financial pressures in the whole economy are reckoned with and "lovely" soundbites are supported by evidence (a difficult ask from subjects of a nanny state)
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