Health benefits for health and social care clients attending an integrated health and social care day unit (IHSCDU): a before and after pilot study with a comparator group

It is thought that integrating health and social care provision can improve services, yet few evaluations of integrated health and social care initiatives have focused on changes in clinical outcomes and used comparator groups. The aim of this pilot study was to identify whether attendance at an integrated health and social care day unit (IHSCDU) affected selected outcomes of functional mobility, number of prescribed medications and physical and psychological well-being. A secondary aim was to examine the utility of the tools to measure these outcomes in this context; the feasibility of the recruitment and retention strategy and the utility of the comparator group. A before-and after comparison design was used with non- randomised intervention and comparator arms. The intervention arm comprised 30 service users attending the IHSCDU and the comparator arm comprised 33 service users on a community nursing caseload. Measures of functional mobility (Barthel’s Index) and physical and psychological well-being (SF-12) were taken from all participants in both arms at three data collection points: baseline, four and nine months later, between November 2010 and September 2012. Participants and outcomes were identified prospectively and in both arms, the individual was the unit of assignment. No significant changes were noted in functional mobility and psychological well-being and the number of medications prescribed increased in both arms. There was a trend towards a significant difference between study arms in the change in the SF-12 physical health outcome measure and this outcome measure could be usefully explored in future studies. The recruitment and retention strategy was feasible although our comparator group had some limitations in not being closely matched in terms of age, functional mobility and mental wellbeing

Patient monitoring: number of participants with documentation of each problem.

<p>* Guidelines appended to the Profile offered definitions of acceptable ranges of measurement and standards. Guidelines are available on request.</p><p>2 participants joined late and 2 were lost to the study.</p

Total number of problems addressed per participant at each step in each site.

<p>Bold text indicates roll-out of medicines’ monitoring and Profile administration 1 month before these data collection points (occasions when researchers extracted data from participants’ records). n = number of service users in the site. One participant from site 4 passed away between steps 3 & 4. One participant from site 5 was hospitalised between steps 3 & 4. Participants joined site 5 at steps 2 and 3. Problems explored are listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.t005" target="_blank">Table 5</a> and on the Profile, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s001" target="_blank">S1 appendix</a>. Fuller versions of these tables, including medians and 25^th = 75^th centiles are in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s005" target="_blank">S1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s006" target="_blank">S2</a> tables.</p

Recruitment, Retention, Demographics and Prescription medicines at study entry.

<p>* Categorisation follows a needs assessment. Service users are assessed by NHS nurses and designated as needing nursing care or residential care. Assessments are usually based on the Royal College of Nursing’s (2004) ‘Nursing assessment and Older People An RCN Toolkit’. London, RCN: <a href="http://www.rcn.org.uk/__data/assets/pdf_file/0010/78616/002310.pdf" target="_blank">http://www.rcn.org.uk/__data/assets/pdf_file/0010/78616/002310.pdf</a></p><p><b>**</b> Any combination preparations were counted as a single item. Enumerating the active ingredients of each product would have been impractical, particularly for antacids and multivitamins.</p><p>Recruitment, Retention, Demographics and Prescription medicines at study entry.</p

The medication chain.

<p>The medication chain.</p

Number of prescribed medicines in each step for each site.

<p>Bold text indicates roll-out of medicines’ monitoring and Profile administration 1 month before these data collection points (occasions when researchers extracted data from participants’ records). n = number of service users in the site. One participant from site 4 passed away between steps 3 & 4. One participant from site 5 was hospitalised between steps 3 & 4. Participants joined site 5 at steps 2 and 3. Problems explored are listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.t005" target="_blank">Table 5</a> and on the Profile, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s001" target="_blank">S1 Appendix</a>. Fuller versions of these tables, including medians and 25^th = 75^th centiles are in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s007" target="_blank">S3 table</a>.</p

Profile Effect on selected outcomes: adjusted analyses.

<p>* adjusted for Step, age, number of medicines at baseline, antipsychotics, antiepileptics, antidepressants and SSRIs at baseline;</p><p>** ICC, intracluster correlation coefficient, based on raw data;</p><p>† number of medicines recorded as prescribed at baseline.</p><p>Notes: D = raw, observed (unadjusted) difference in the same units as the variable; β = β coefficient of profile effect or effect size in the same units as variable; OR = raw (unadjusted odds ratio); aOR = adjusted Odds Ratio, exponent of β. ADL = activities of daily living. n represents the number of data collection points.</p

Problems addressed with and without the Profile: total numbers and examples.

<p>Visits to dentists and opticians were compared ‘before and after’ (see analysis and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.t006" target="_blank">Table 6</a>). ADLs—activities of daily living.</p

Numbers of participants with any change made to any of their prescribed medications at each step in each site.

<p>Bold text indicates roll-out of medicines’ monitoring and Profile administration 1 month before these data collection points (occasions when researchers extracted data from participants’ records). n = number of service users in the site. One participant from site 4 passed away between steps 3 & 4. One participant from site 5 was hospitalised between steps 3 & 4. Participants joined site 5 at steps 2 and 3. Problems explored are listed in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.t005" target="_blank">Table 5</a> and on the Profile, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s001" target="_blank">S1 Appendix</a>. Fuller versions of these tables, including medians and 25^th = 75^th centiles are in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0140203#pone.0140203.s007" target="_blank">S3 Table</a>.</p

Case Reports of benefits of Profile use.

<p>Case Reports of benefits of Profile use.</p