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Long term illness focus halves emergency costs

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Refocusing district nursing teams on older people with more than one long term condition can cut emergency bed day costs in half, a new study shows.

Research from Northern Ireland shows a significant saving when part of a community nursing workforce is reconfigured into a long term illness case management team.

The nurses teach [patients] how to look after themselves so they can stay out of hospital as long as possible

The study of 600 patients, looking at clinical and cost effectiveness, started in June 2008 and was presented at the Taking Charge: Evidence for Self Care in the UK conference organised by the NHS Confederation last month.

After nine months the secondary care cost for the control group was £408,000, compared with £115,000 for those cared for by a long term illness case management team.

The teams base nurses in GP localities where they proactively manage a caseload of between 40 and 50 patients at high risk of hospitalisation.

The band 7 nurses use skills including health assessment and independent prescribing to work with patients who have multiple long term conditions, including chronic obstructive pulmonary disease, diabetes and asthma.

Marina Lupari, the assistant director for nursing research at the Northern Health and Social Care Trust, said that teaching patients how to manage their own conditions was a vital part of the project’s success.

“The nurses teach [patients] how to look after themselves so they can stay out of hospital as long as possible. The nurse then has time in her duty [shift] and can respond to her patient when they need it,” she said.

“The big saving is in bed days, this is pressure off the hospital. I always worried about the effect on the carers of having people at home the whole time but the caregivers results showed this was not the case. Patients just love it.”

She added: “One man talked about his relative having 55 A&E attendances [a year] and now having none.”  

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