Exploring the impact of different approaches to healthcare support for older care home residents in Greater Manchester on ambulance services and unplanned hospital admissions

Hargreaves, Claire and Tucker, Sue and Hughes, Jane and Hothersall, Grace and Patterson, Megan and Gillan, Vincent and Challis, David (2024) Exploring the impact of different approaches to healthcare support for older care home residents in Greater Manchester on ambulance services and unplanned hospital admissions. Journal of Long-Term Care, 2024. pp. 489-499.

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Abstract

Context: Meeting the healthcare needs of care home residents is an international concern. In England, three approaches to enhance usual care provided by primary care general practitioners have been identified: additional direct (face-to-face) support; additional indirect support (like staff training); and a combination of both. Objectives: To investigate the impact of these approaches on ambulance call-outs and unplanned hospital admissions. Methods: Survey of care home managers to establish the content of healthcare services provided to homes in Greater Manchester. Linking of survey data to routinely collected locality data on ambulance call-outs and unplanned hospital admissions. Data relates to the 12 months from April 2017. Analysis of the relationship between these events and different approaches to healthcare support. Findings: Completed surveys were received from 255/407 (63%) care homes. Most received additional healthcare support to that provided by general practitioners: 49% received additional direct support, 5% additional indirect support and 35% both. In the study period there were 17,980 ambulance call-outs and 14,539 unplanned hospital admissions for older care home residents (aged 75+). Ambulance call-out and unplanned hospital admission rates were higher in homes with additional direct support than those with additional indirect support or both. Limitations: The study used broad categories of intervention. More fine-grained analysis of their components and resident characteristics might have assisted in the interpretation of the findings. Implications: These findings could inform initiatives regarding the composition and practice of multidisciplinary teams providing enhanced healthcare support to care home residents. Future research should explore which specific components of additional direct and indirect support are most important.