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Matrons scheme unlikely to deliver cut in admissions

GPs should not expect the Government's community matrons scheme to reduce unplanned admissions or hospital bed days, a wide-ranging new review warns.

The study, which examined data from around the world, found little or no evidence that active case management would have its intended effect on hospital use. It suggests primary care will struggle to hit the Government's key target of a 5 per cent reduction in unplanned bed days by 2008.

The researchers, from the Health Services Management Centre at the University of Birmingham, warned the evidence was 'inconsistent' and 'unclear' for the benefits of case management, which uses nurses to co-ordinate care for frail elderly patients with long-term conditions.

Among studies of active case management by primary care nurses, only two trials found it reduced unplanned admissions, another found it increased admissions, while three reviews and seven additional trials found no effect.

One trial found case management reduced length of stay in hospital, but another found it might increase length of stay, while a review and two other trials found no effect.

The report, commissioned by Birmingham and the Black Country strategic health authority to examine a variety of approaches for reducing admissions, concluded: 'There is inconsistent evidence for the effects of case management on unplanned admissions and length of stay, though most evidence is negative.'

Dr Tony Snell, medical director of Birmingham and the Black Country SHA, said: 'There wasn't evidence one way or the other. Some PCTs have gone for the community matron model and we're not sure how that's going to work out.

'If it doesn't produce the business, we're going to have to change. The bottom line is we need to reduce admissions.'

Professor Rod Sheaff, professor of health services research at the University of Plymouth, warned case management was not a 'magic bullet'.

Professor Sheaff, who is evaluating the US-style Evercare case management pilots, added: 'Case management is a way of routing people through the health system but we also need something to route them into.'

Dr Bruce Allan, a GP in Worthing, West Sussex, criticised the Government for rolling community matrons out prematurely. 'It's been rolled out without due care and attention. We've just started an audit of our PCT scheme but we have not been able to show any measurable benefit.'

Bumpy ride for matrons scheme

January 2005

DoH announces plans to employ 3,000 community matrons to do active case management by March 2007

February 2005

Interim evaluation of the US-style Evercare pilots found active case management was unlikely to cut hospital admissions by more then 1 per cent

September 2005

A Cochrane review found little evidence from trials of patients with COPD that case management could cut hospital admissions or mortality

September 2005

GP research published in Age

and Ageing on a pilot of active case management found it increased emergency


April 2006

Report commissioned by Birmingham and the Black Country SHA finds most

evidence on case management is negative

Summer 2006

The final verdict on the Evercare pilots is due from the National Primary Care Research and Development Centre

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