Table A.1 Developments in service delivery: summary of articles examined for shared care
| ID and authors | Research setting and year of study | Study design | Sample size | Topic of document | Key results and conclusions | Level of evidence | Quality score (AGREE) (%) |
|---|---|---|---|---|---|---|---|
| Kennedy et al683 | UK (1999–2000) | RCT | 700 Patients | Impact of a guidebook for self care | A whole systems approach to self management using a guidebook developed with patients and with physicians trained in patient centred care improves clinical outcomes and leads to cost effective use of NHS services. This method should receive more widespread use in chronic disease management, and seems likely to improve patient satisfaction and reduce health expenditure without evidence of adverse effect on disease control. Evidence suggests that further attention needs to be placed on self referral and access arrangements and a redistribution of control to patients through increased adherence to patient centred norms on the part of consultants | 1 | 93 |
| Williams et al679 | UK (1995–96) | RCT | 180 Patients | Open access follow-up for IBD | Open access follow-up delivers the same quality of care as routine outpatient care and is preferred by patients and GPs. It uses fewer resources in secondary care, but total resource use is similar. Better methods of ensuring urgent access to outpatient clinics are needed | 1 | 73 |
| Robinson et al681 | UK (2001) | RCT | 203 Patients | Guided self management and patient directed follow-up | Self management of ulcerative colitis accelerates treatment provision and reduces doctor visits, and does not increase morbidity. This approach could be used in long term management of many other chronic diseases to improve health service provision and use, and to reduce costs. Nursing staff, appointment clerks, and secretarial teams need to be willing to assist with implementation of changes, and one person from the medical team needs to be available for patients to contact for advice | 1 | 66 |
| Shepperd and Iliffe689 | International (1996–2001) | Systematic review | 16 Trials | Hospital versus home care | This review does not support the development of hospital at home (active treatment by healthcare professionals in the patient’s home) as a cheaper alternative to inpatient care. Providing that the views of carers are taken into account, early discharge schemes for patients recovering from elective surgery and elderly patients with a medical condition may have a place in reducing the pressure on acute hospital beds | 1 | 66 |
| Kennedy et al682 | UK (1999–2000) | RCT | 700 Patients | Self management in IBD | Adoption of guided self management was generally popular with both patients and clinicians, reduced use of hospital services without burden to primary care, and increased quality of care without an adverse effect on disease control at the same time as reducing cost. More widespread adoption of this programme for patients with IBD and other chronic medical disorders, particularly those with relapsing remitting patterns, now seems indicated | 1 | 75 |
| Ham et al675 | Comparison between UK and USA practice (2000–01) | Analysis of routine data | Hospital episode data for 2000 and 2001; data from Kaiser and Medicare systems | Comparison of hospital bed use | There is scope for hospital beds to be used in a different way in the NHS; primary and secondary care should be integrated to give priority towards self care; the NHS can learn from the Kaiser approach | 2− | 66 |
| O’Hanrahan and Irving688 | UK (1992; data taken between 1977 and 1991) | Analysis of routine data | 400 Records | Role of HPN | Recent reports have highlighted the palliative benefits of HPN, and the way in which it facilitates compassionate home care for carefully selected patients with inoperable malignant bowel obstruction. However, it is unlikely that the current financial constraints within which the NHS operates could cope with the demand associated with HPN | 2− | 66 |
| Evans et al686 | Canada (1996–2000) | Analysis of routine data | 15 Patients | Home total parenteral nutrition (HPN) | Patients receiving HPN benefit from reduced stress on the family, increased independence, and ability to perform normal work and study activities. All patients preferred HPN to hospitalisation and reported good or excellent quality of life. HPN is a safe alternative to hospitalisation or early surgery of patients with the complication IBD | 2− | 61 |
| Kennedy et al684 | UK (2003) | Survey of patients | 147 Responses | Development of self help book for patients with IBS | Guided and practical ways of support are required for people with IBS who want to self manage their condition. Patient information is essential for shared decision-making, but most information is not patient centred and often does not involve the patient at all. All information should include patients at each development stage | 2− | 57 |
| Robinson680 | UK (2004) | Expert commentary | NA | IBD and patient empowerment | Self care is a normal human function and accounts for the management of three quarters of all episodes of ill health. More formalised applications include patients and doctors working collaboratively to develop a set of guidelines which patients use to manage their chronic disease themselves. Clinicians may be reluctant to pass control of treatment changes to patients, particularly the use of steroids. There are indications that passing ownership of management back to patients may improve compliance as patients realise their own responsibilities for remaining well | 3 | 59 |
| DoH674 | UK, NHS (2004) | Strategy and commentary | NA | Improving chronic disease management | A key approach to managing chronic disease is to support people to take an active role in managing their own care, specific conditions, and approaches that prevent these conditions from getting worse. This is linked with the development of GPwSI to provide patient centred care | 3 | 39 |
| RCP and RCGP677 | UK, NHS (2004) | Report/commentary | NA | Service provision | There should be active support for the development of GPs with special interests | 4 | 67 |
| BSG and RCP489 | UK (2003) | Expert commentary and recommendations | NA | GI service provision | Services and high quality care for patients and their families should be delivered locally whenever possible. Emphasis should be placed on integrating primary and secondary care, and moving hospital services closer to the patient | 4 | 43 |
| DoH673 | UK, NHS (2004) | National framework and commentary | NA | Outline of plans for national standards | Emphasis on the importance of improving the whole experience of patients, with particular attention to tailoring services to patients with long term conditions, promoting independence for older people, and supporting self care and the expert patient | 4 | 36 |