What works in managing complex conditions in older people in primary and community care? A state-of-the-art review

Rachael Frost; Greta Rait; Alison Wheatley; Jane Wilcock; Louise Robinson; Karen Harrison Dening; Louise Allan; Sube Banerjee; Jill Manthorpe; Kate Walters

doi:10.1111/hsc.13085

What works in managing complex conditions in older people in primary and community care? A state-of-the-art review

Rachael Frost^*, Greta Rait, Alison Wheatley, Jane Wilcock, Louise Robinson, Karen Harrison Dening, Louise Allan, Sube Banerjee, Jill Manthorpe, Kate Walters

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

33 Citations (Scopus)

Abstract

The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.

Original language	English
Pages (from-to)	1915-1927
Number of pages	13
Journal	Health and Social Care in the Community
Volume	28
Issue number	6
DOIs	https://doi.org/10.1111/hsc.13085
Publication status	Published - 1 Nov 2020

Keywords

ageing
chronic disease management
chronic/long-term conditions
community care
primary care

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10.1111/hsc.13085

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abstract = "The number of older people living with complex health conditions is increasing, with the majority of these managed in primary and community settings. Many models of care have been developed to support them, however, there is mixed evidence on their value and they include multiple overlapping components. We aimed to synthesise the evidence to learn what works for managing complex conditions in older people in primary and community care. We carried out a state-of-the-art review of systematic reviews. We searched three databases (January 2009 to July 2019) for models of primary and community care for long-term conditions, frailty, multimorbidity and complex neurological conditions common to older people such as dementia. We narratively synthesised review findings to summarise the evidence for each model type and identify components which influenced effectiveness. Out of 2,129 unique titles and abstracts, 178 full texts were reviewed and 54 systematic reviews were included. We found that the models of care were more likely to improve depressive symptoms and mental health outcomes than physical health or service use outcomes. Interventions including self-management, patient education, assessment with follow-up care procedures, and structured care processes or pathways had greater evidence of effectiveness. The level of healthcare service integration appeared to be more important than inclusion of specific professional types within a team. However, more experienced and qualified nurses were associated with better outcomes. These conclusions are limited by the overlap between reviews, reliance on vote counting within some included reviews and the quality of study reports. In conclusion, primary and community care interventions for complex conditions in older people should include: (a) clear intervention targets; (b) explicit theoretical underpinnings; and (c) elements of self-management and patient education, structured collaboration between healthcare professionals and professional support. Further work needs to determine the optimal intensity, length, team composition and role of technology in interventions.",

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AU - Harrison Dening, Karen

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AU - Banerjee, Sube

AU - Manthorpe, Jill

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ER -

What works in managing complex conditions in older people in primary and community care? A state-of-the-art review

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Keywords

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