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

Research output: Contribution to journalReview article

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What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. / Frost, Rachael; Rait, Greta; Wheatley, Alison; Wilcock, Jane; Robinson, Louise; Harrison Dening, Karen; Allan, Louise; Banerjee, Sube; Manthorpe, Jill; Walters, Kate.

In: Health and Social Care in the Community, Vol. 28, No. 6, 01.11.2020, p. 1915-1927.

Research output: Contribution to journalReview article

Harvard

Frost, R, Rait, G, Wheatley, A, Wilcock, J, Robinson, L, Harrison Dening, K, Allan, L, Banerjee, S, Manthorpe, J & Walters, K 2020, 'What works in managing complex conditions in older people in primary and community care? A state-of-the-art review', Health and Social Care in the Community, vol. 28, no. 6, pp. 1915-1927. https://doi.org/10.1111/hsc.13085

APA

Frost, R., Rait, G., Wheatley, A., Wilcock, J., Robinson, L., Harrison Dening, K., Allan, L., Banerjee, S., Manthorpe, J., & Walters, K. (2020). What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. Health and Social Care in the Community, 28(6), 1915-1927. https://doi.org/10.1111/hsc.13085

Vancouver

Frost R, Rait G, Wheatley A, Wilcock J, Robinson L, Harrison Dening K et al. What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. Health and Social Care in the Community. 2020 Nov 1;28(6):1915-1927. https://doi.org/10.1111/hsc.13085

Author

Frost, Rachael ; Rait, Greta ; Wheatley, Alison ; Wilcock, Jane ; Robinson, Louise ; Harrison Dening, Karen ; Allan, Louise ; Banerjee, Sube ; Manthorpe, Jill ; Walters, Kate. / What works in managing complex conditions in older people in primary and community care? A state-of-the-art review. In: Health and Social Care in the Community. 2020 ; Vol. 28, No. 6. pp. 1915-1927.

Bibtex Download

@article{707adf4e80aa49ec9d2c687d7901fef7,
title = "What works in managing complex conditions in older people in primary and community care? A state-of-the-art review",
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.",
keywords = "ageing, chronic disease management, chronic/long-term conditions, community care, primary care",
author = "Rachael Frost and Greta Rait and Alison Wheatley and Jane Wilcock and Louise Robinson and {Harrison Dening}, Karen and Louise Allan and Sube Banerjee and Jill Manthorpe and Kate Walters",
year = "2020",
month = nov,
day = "1",
doi = "10.1111/hsc.13085",
language = "English",
volume = "28",
pages = "1915--1927",
journal = "Health and Social Care in the Community",
issn = "0966-0410",
publisher = "Wiley-Blackwell",
number = "6",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - What works in managing complex conditions in older people in primary and community care? A state-of-the-art review

AU - Frost, Rachael

AU - Rait, Greta

AU - Wheatley, Alison

AU - Wilcock, Jane

AU - Robinson, Louise

AU - Harrison Dening, Karen

AU - Allan, Louise

AU - Banerjee, Sube

AU - Manthorpe, Jill

AU - Walters, Kate

PY - 2020/11/1

Y1 - 2020/11/1

N2 - 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.

AB - 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.

KW - ageing

KW - chronic disease management

KW - chronic/long-term conditions

KW - community care

KW - primary care

UR - http://www.scopus.com/inward/record.url?scp=85087869476&partnerID=8YFLogxK

U2 - 10.1111/hsc.13085

DO - 10.1111/hsc.13085

M3 - Review article

AN - SCOPUS:85087869476

VL - 28

SP - 1915

EP - 1927

JO - Health and Social Care in the Community

JF - Health and Social Care in the Community

SN - 0966-0410

IS - 6

ER -

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