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Government jumps gun on disease management pilot

The Department of Health is rushing into an unprecedented national rollout of its US-style chronic disease management programme, pre-empt- ing results from its own pilot studies.

A letter to strategic health authority chief executives has ordered the case management approach favoured by Tony Blair to be implemented throughout the country.

The instructions come just weeks after Health Secretary John Reid launched 28 demonstrator sites to test whether active case management could cut hospital admissions.

Professor Chris Ham, director of the department's strategy unit, said the intention was to build on the 'relatively small-scale projects that have taken place'. He said: 'There's going to be increasing emphasis on chronic disease.'

But Dr Rod Sheaff, evaluating Evercare at the National Primary Care Research and Development Centre, said: 'UK evidence for this is very slight because it's such early days. I get the impression ministers are under pressure to roll this out.'

Professor Allyson Pollock, professor of public health policy at UCL, said Evercare's success in the US was no guarantee it would work in the UK, where patients are treated 'on the basis of need'.

The case management approach is modelled on the

US Evercare and Kaiser Permanante schemes, now being piloted in 19 PCTs nationwide.

The nine Evercare schemes, using specially trained nurses to keep elderly patients out of hospital, are the subject of a study by the National Primary Research and Development Centre set up by the Department in 1995 to assess its policy initiatives.

But interim results are not due until September and full findings not expected until March 2006. A separate evaluation by Evercare's owners, US health management organisation United Health Group, will not be ready for another six months.

Nevertheless, the department's head of primary care, Gary Belfield, made clear he wanted to see the schemes rolled out nationally in his letter last week. He said: 'Many SHAs are keen to take this work forward as quickly as possible.

'It therefore seems appropriate to consider broadening our approach from 28 single PCT case management sites to one that spans whole SHAs.'

What is case management?

Identifying high-risk patients, using criteria such as unplanned hospital admissions or multiple chronic conditions

Using case-managers to co-ordinate care across general and specialist services

Involving patients in the management of their condition

Minimising unnecessary hospital visits and admissions

By Emma Wilkinson

Case study

Dr Tony Fielding, a GP in Bristol leading one of the Evercare pilots, believes the scheme is running well but it is too early to roll-out nationally.

In Dr Fielding's area four advanced primary nurses have been trained to educate and monitor high-risk elderly patients.

'There are lots of people in our pilot who we feel we have managed well and prevented from going into hospital,' he said.

'I would really like to see some good evidence before this scheme is rolled out because the population studied in the US was very different,' he added.

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