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At the heart of general practice since 1960

Community matrons scheme a let-down

By Cato Pedder

The Government's much-vaunted community matrons scheme is not sufficient to cut hospital admissions or length of hospital stay, a new study reports.

The first controlled evaluation of a pilot of Evercare case management – on which the matrons scheme was based – found the intervention had no greater effect on admissions than standard GP care.

The report came as a Pulse investigation found none of the nine PCTs that piloted the US Evercare model is continuing with active case management in its original form. Eight have substantially altered the scheme to attain benefits, while one has ceased it altogether.

The new evidence is a blow to the Government's drive to meet its target for reducing hospital bed days by 5 per cent by 2008, and suggests only PCTs which invest in add-ons to the community matrons scheme will see reductions in admissions.

The study of 172 patients in Bexley PCT found monthly admissions under Evercare fell from 0.14 to 0.12 per patient over six months, but also dropped substantially in controls, from 0.25 to 0.10.

Both groups saw reductions in length of hospital stay reported the study, published in the British Journal of Nursing.

Study leader Dr Hannah Patrick, consultant in public health medicine at Bexley PCT, said: 'Admission rates for patients with recurrent admission fell irrespective of any intervention. This illustrates the importance of having a comparator group before drawing potentially misleading conclusions on the apparent effects of Evercare-style intervention.'

The National Primary Care Research and Development Centre's final evaluation of the Evercare pilots is due to be published over the summer.

Professor Rod Sheaff, a senior member of the evaluation team and professor of health services research at the University of Plymouth, told Pulse the scheme did have benefits, but mainly for improving access to primary care for vulnerable older people, rather than in cutting admissions.

cpedder@cmpi.biz

Evercare on trial

• Introduced into nine PCT pilot sites in England in April 2003

• Patients aged over 65 with two or more unplanned hospital admissions identified for inclusion

• A case controlled study at Bexley PCT found no difference

in rates of hospital admissions

or length of stay

• Eight of the PCT pilots have expanded the Evercare model, introducing adaptations such

as more training for nurses or

a broadening of qualifying conditions; one PCT has discontinued the Evercare

system

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