Written evidence submitted by the University of Bristol (HSC0013)

 

This review was conducted by Dr Alyson Huntley and her team based at the Centre for Academic Primary Care, University of Bristol.

https://research-information.bris.ac.uk/en/persons/alyson-l-huntley

 

It was funded by the National Institute of Health, School of Primary Care Research (NIHR-SPCR) as part of the SPCREvidence Synthesis Working Group. https://www.spcr.nihr.ac.uk/eswg

 

We include below the abstract and two key tables from the review. The second table summarises the evidence.

 

the full text is available at   https://f1000research.com/articles/9-857

 

 

 

SYSTEMATIC REVIEW

Does health and social care provision for the community dwelling older population help to reduce unplanned secondary care, support timely discharge and improve patient well-being? A mixed method meta-review of systematic reviews

 [version 1; peer review: 1 approved]

Shoba Dawson Patience Kunonga2, Fiona Beyer2, Gemma Spiers2, Matthew Booker1, Ruth McDonald3, Ailsa Cameron4, DawnCraig2, Barbara Hanratty5, Chris Salisbury1, Alyson Huntley1

 

1

Author details

1 Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
2 Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK, Newcastle, UK
3 Alliance Manchester Business School, University of Manchester, Manchester, UK
4 School for Policy Studies, University of Bristol, Bristol, UK
5 Population Health Sciences Institute, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, UK, Newcastle, UK

Shoba Dawson
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

 

 

 

 

 

 

 

Abstract

Background: This study aimed to identify and examine systematic review evidence of health and social care interventions for the community-dwelling older population regarding unplanned hospital admissions, timely hospital discharge and patient well-being.
Methods: A meta-review was conducted using Joanna Briggs and PRISMA guidance. A search strategy was developed: eight bibliographic medical and social science databases were searched, and references of included studies checked. Searches were restricted to OECD countries and to systematic reviews published between January 2013–March 2018. Data extraction and quality appraisal was undertaken by one reviewer with a random sample screened independently by two others.
Results: Searches retrieved 21,233 records; using data mining techniques, we identified 8,720 reviews. Following title and abstract and full-paper screening, 71 systematic reviews were included: 62 quantitative, seven qualitative and two mixed methods reviews. There were 52 reviews concerned with healthcare interventions and 19 reviews concerned with social care interventions. This meta-review summarises the evidence and evidence gaps of nine broad types of health and social care interventions. It scrutinises the presence of research in combined health and social care provision, finding it lacking in both definition and detail given. This meta-review debates the overlap of some of the person-centred support provided by community health and social care provision. Research recommendations have been generated by this process for both primary and secondary research. Finally, it proposes that research recommendations can be delivered on an ongoing basis if meta-reviews are conducted as living systematic reviews.
Conclusions: This meta-review provides evidence of the effect of health and social care interventions for the community-dwelling older population and identification of evidence gaps. It highlights the lack of evidence for combined health and social care interventions and for the impact of social care interventions on health care outcomes.
Registration: PROSPERO ID CRD42018087534; registered on 15 March 2018.

Keywords

meta-review, systematic reviews, health care, social care, community-dwelling older population, unplanned admissions, patient well-being

 

 

Table 1: Evidence map of health and social care interventions

Circled numbers relate to number of included systematic reviews per condition and outcome

Outcome

Admissions/

readmissions

Timely discharge

Quality of life

Patient experience

CARE IN THE COMMUNITY

 

 

 

 

Composite reviews

Self-management

 

 

 

 

Older

COPD

Heart failure

Stroke

Rehab /Exercise

 

 

 

 

COPD

Heart failure

Mixed conditions

OVF

Case management

 

 

 

 

Older

Heart failure

Parkinson’s

Dementia

Med review

 

 

 

 

Older

Vaccination

 

 

 

 

Older

URGENT

CARE

 

 

 

 

Composite reviews

ED interventions

 

 

 

 

Older

DISCHARGE

CARE

 

 

 

 

Composite reviews

Transitional care

 

 

 

 

Older

COPD

Heart failure

Case management

 

 

 

 

Heart failure

 

FORMAL

SOCIAL CARE

 

 

 

 

Composite reviews

Reablement

 

 

 

 

Older

SYNTHETIC

SOCIAL CARE

 

 

 

 

Social support

 

 

 

 

Older

Dementia

Social isolation

 

 

 

 

Older

Abbreviations: COPD Chronic Obstructive Pulmonary Disease; OVF Osteoporotic Vertebral Fracture

 


 

Table 2: Evidence summary at systematic review level for efficacy for health and social care interventions by outcome

Outcome

(qualitative & quantitative evidence integrated)

Evidence for positive impact

Evidence for no impact

Hospital admissions

 

 

Older population

Consultant geriatrician-led comprehensive geriatric assessment in ED.C

Discharge & transitional care from hospital to home. A, E 

Influenza vaccination for nursing home residents. A

Structured educational programmes. C

Hospital to nursing home interventions. C

Palliative care services. C

Implementation of a clinical pathway for lower respiratory tract infections. C

Geriatric specialist services for nursing home residents. C

Community case management. A

 

Medication review. A

Nurse-led geriatric care in ED. A

Reablement. B

 

COPD

Rehabilitation & post rehabilitation support. A, E   

Influenza vaccination. A   

Discharge & transitional care from hospital to home. A   

Hospital at Home interventions. A   

Self-management. A

 

Heart failure

Discharge & transitional care from hospital to home. A   

Hospital-initiated case management. A,E   

Supervised exercise. A

Community case management. A, E

Dementia

 

Community case management. B

Timely hospital discharge

 

 

Older population

Reablement. B, E

Discharge and transitional careC

Heart failure

Hospital-initiated case management. A, E

 

Quality of life

 

 

Older population

Self-management. A    

Personal assistance from a paid worker for older people with physical and/or mental impairment. B

Physical activity for people with long-term conditions and non-frail older people. B

Reablement. A

Face to face social isolation interventions based on programmes to prevent social isolation. B

Psychosocial interventions. B

Socially stimulating groups. B

Health promotion. B

Supporting wellbeing in retirement. B

Social support and social participation. B

Information and communication interventions for social isolation but not loneliness. B

E-interventions (e.g. internet training) on loneliness. D

Medication review. A

 

COPD

Breathing techniques and Tai Chi. A

Hospital at home for (≤6 months). A

Discharge & transitional care for COPD. C

Post rehabilitation support. A

 

Heart failure

General exercise and Tai Chi. A

Hospital at home. A

Discharge and transitional care. A

 

Stroke

Self-management. A

 

Dementia

Informal social support such as social clubs or groups. B

 

Parkinson’s

 

Community case management. B

Key: A Evidence from at least one meta-analysis of randomized controlled trial data. (meta-analysis evidence) B Evidence from predominantly RCT data, but no meta-analysis performed. (Narrative evidence)

C Evidence from 2 or less RCTs. (Limited evidence) D Evidence from predominately non- RCT evidence. (Low quality evidence) E Evidence from qualitative evidence with meta-synthesis.

(meta-synthesis evidence)

 

March 2021