Organising general practice for care homes: A multi-method study

Description

Aims

To identify effective and cost effective ways of organising general practice for care homes and evaluate the impact on residents, general practice and care home staff. Our research questions are

• in what ways is the organisation of general practice for care homes associated with better resident outcomes and experiences?
• what are the implications of different models of GP involvement for residents’ service use and costs?
• what are the perspectives of residents and relatives, commissioners and staff in general practice and care homes on different ways of organising general practice for care homes; which are acceptable and associated with positive experiences?

Method

A case study approach will be used, deploying the following multi-methods:

Preparatory work: Email survey of practice managers in case study area to describe GP service organisation to care homes, cluster (or latent class) analysis to develop a simple typology of service organisation for use in the following analyses.

Work package 1 (Research question 1): Comparative analyses of chronic disease management, patient and system outcomes for care home residents in 3 case study areas. Three sites will be selected; two with innovative, contrasting ways of organising general practice for care homes and one where there has been no systematic change to services (usually multiple GPs for each care home). At each case site, patient level data from GP records in the ResearchOne database will be analysed to compare achievement on selected measures, before and after the introduction of changes to GP organisation in the innovation areas and over similar time period in ‘usual care’ areas. Outcome measures will include: hospital admission and readmission rates, potentially avoidable (ambulatory care sensitive) admissions, measures of prescribing quality, GP and practice nurse contacts (in person and by telephone), measures of relational continuity and chronic disease management. Comparisons will be made within and across case studies, controlling for resident characteristics.

Work Package 2 (Research question 2): Economic evaluation with costs assigned to the service utilisation identified in WP1, and comparisons conducted within and between GP care home models.

Work Package 3 (Research question 3): Individual qualitative interviews in the case study sites with residents, relatives, GP and care home staff and commissioners, to explore perceptions of the context, structure and processes of service delivery to care homes, positive and negative consequences of different ways of working for staff and residents. Participants will be drawn from sites with particularly effective care and others where resident data point to worse care.

Background

General practice provides first line medical care for care home residents in the UK. Proactive, holistic primary care offers the potential to reduce avoidable admissions to hospital, and enhance residents’ health, wellbeing and quality of life. Yet, there is some evidence, and a widely held perception, that care home residents do not have equitable access to high quality primary care. There is great heterogeneity in the organisation of general practice services for care homes, both in the number of general practices providing services to an individual care home, and in nature, frequency and regularity of primary care contacts with a particular home. This study will address the question of whether and how the organisation of GP services impacts on care home residents’ outcomes and staff experiences, in order to identify effective ways of serving this important group.

People

Principal Investigator:
Professor Barbara Hanratty, University of Newcastle

Co-investigators:
Professor Karen Spilsbury, University of Leeds 
Professor Heather Gage, University of Surrey
Dr Katie Brittain, University of Newcastle
Dr Rachel Clare Duncan, University of Newcastle
Professor Fional Matthews, University of Newcastle

Funding body: Funded by NIHR Health Services and Delivery Research (HSDR) Programme (£225,885)
(£387,819)

Contact: Professor Karen Spilsbury, University of Leeds