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Evaluation of The Lewisham Proactive Primary Care Project.
Evaluation of The Lewisham Proactive Primary Care Project.
Evaluation of The Lewisham Proactive Primary Care Project.
Patients became significantly healthier as a result of PPC. After three telephone care
calls, the self-assessed general health score, where 10 is the best and 1 is the worst,
increased from 6.58 to 7.10 (p = 0.000).
Patients significantly improved their health behaviour. 68% of the patients
transformed their health-compromising behavior to health-enhancing behavior, such as
doing exercises, eating healthy and keeping optimistic.
Patients rated the project highly in providing motivation for self-management,
someone to talk to and information about community services. Less benefit was
seen in enhancing their health knowledge.
PPC reduced anxiety by 21%
The average monthly number of GP appointments by this population increased by
about 11% (p = 0.000) and there was a significant increase of 38% (p = 0.000) in the first
month after the start of the project.
The average monthly number of telephone consultations from this population
increased by about 20% 0p = 0.038).
There was no significant change in the number of home visits.
The average monthly outpatient attendances were reduced by about 27% (p =
0.005). Patients appeared to transfer their health activity from secondary to primary care.
The unit cost per patient is about 40. The estimated net cost of a 6-month Proactive
Primary Care project involving 683 patients, taking changing utilisation into account, is
about 24,422.
Introduction
Lewisham CCG carried out a Proactive Primary Care (PPC) project as one of its strategic
priorities: providing better support for patients with long term conditions (LTCs). The
programme is based on a Michigan study which showed significant improvements in health
behaviour following telephone support to patients with LTCs.
We targeted patients with two or more LTCs gathered from practice lists. Practices can
exclude inappropriate patients and add others they think will benefit. Patients are called three
times over three months by trained telephoners using motivational interview techniques.
They focus on the issues that matter to patients and do not push a particular health agenda.
They explore:
The patients current health
Their confidence in managing rapid deterioration in their condition
What health issues people would like to tackle and supporting them in doing that
Linking patients with relevant local third sector or statutory agencies where helpful.
The feasibility of the approach was tested in a PPC Pilot study in 2012 with 70 patients from
Honor Oak Group Practice. After making some adjustments recommended by local practices,
the second stage began in Jan 2014, with five GP practices across Lewisham (Woolstone
Medical Centre, St Johns Medical Center, Rushey Green Practice Group, Amersham Vale
Training Group and Vesta Road Surgery).
Control group
Patients with two or more long term conditions were involved in the test group and another
group of patients with similar health conditions were included in the control group. The control
group was not contacted by anyone. Their notes were searched for use of NHS services, so
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that we could gauge whether the project impacted on service utilisation.
Impact on health
Patients were asked to evaluate their health status as improving, the same or worsening. The
proportions of each status derived from the three calls are shown in Table 1.
Compared with the baseline 1st call, patients felt their health not only improved but stopped
getting worse. Statistically, the improvements between the first call to the third are extremely
significant (p<0.001)
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fewer (7%) thought that having someone to contact was helpful in the first call. Nevertheless,
by the end of the project, 38% of the patients showed great gratitude to the callers. The
telephone calls made them feel that people were concerned about them.
A middle aged man who felt really trapped and housebound, but after talking to us he
had found an exercise class for amputees in his local area.
A man who had been a recluse for many years getting the courage to get a voluntary
job 1 day a week in a charity shop.
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A woman suffering with depression feeling cared about and joining weight watchers
and walking groups even making friends and getting a new job. She feels the calls
were like prompts to change her lifestyle and social life .
I was able to intervene when a patient was facing eviction and liaised with the
housing and the patient. There was an on-going history with the patient/housing due
to anti-social behaviour. The patient was expected to attend a meeting but she was
seriously depressed, not well and had heart problems. I was able to talk with both
parties and set up an amicable meeting.
Conclusion
Evaluating key aspects through a control group gives these outcomes a rare robustness.
PPC improved patients general health and improved their health behavior and lifestyle.
Patients appeared to transfer their health activity from secondary to primary care which
reduced health spend on secondary care. Patients found PPC helpful and actively used
referrals to the third sector. PPC reduced patient anxiety by over 20%.
The PPC approach to risk stratification and intervention makes a positive impact and should
be considered for extension and dissemination.
-------------------------------------------------------------------------------------------------------------------------Acknowledgements
The Evaluation of the Proactive Primary Care Project was commissioned and is currently
overseen by PPC Project Chair (Dr Brian Fisher) and Lewisham CCG Lead (primarily Marie
Searle). With thanks to the dedication and commitment of the telephone callers; to Paul
Chapman who designed the IT data collection system; and to the LSE students and staff
supervisors.