Title: Developing effective strategies to reduce unscheduled care in chronic disease.
Funder: Department of Health (England)

Abstract: Aims and Objectives We aim to develop effective psychosocial strategies to reduce the need for frequent unscheduled care in patients with four common, long term conditions, through a programme of applied health services research. Our objectives are: 1. To systematically synthesise current evidence about psychosocial drivers of unscheduled care, and interventions or strategies to reduce the frequency of unscheduled care in patients with long term conditions. 2. To derive estimates of the frequency and pattern of unscheduled care in patients with: asthma, diabetes, coronary heart disease, and chronic obstructive pulmonary disease as examples of common long term conditions. 3. To develop a ‘red flag’ system that will identify patients with long term conditions who are at risk of becoming frequent users of unscheduled care, and validate it using two NHS databases in separate Trusts. 4. To identify personal reasons for use of unscheduled care including barriers to access for routine care. 5. To develop and evaluate an intervention which will reduce/prevent unscheduled care, whilst maintaining or improving patient benefit. 6. To use statistical and health economic modelling to evaluate patient choices concerning particular aspects of treatment, and estimate the costs and benefits associated with the treatment intervention. Background The reduction of the use of unscheduled care in the NHS is a government priority, and the costs of unscheduled care in some long term conditions account for over half of the total costs of care, regardless of the severity of patients’ symptoms Mental health and psychosocial problems are an important but often ignored driver of health care seeking behaviour in people with long term conditions. Research Plan We shall: 1. Use a whole system model, using our combined expertise in systematic reviews, qualitative work, health economics and user and stakeholder involvement to combine ‘top-down’ and ‘bottom-up’ approaches to identify psychosocial factors which contribute to unscheduled care in long term conditions, and interventions or strategies to reduce the frequency of unscheduled care. 2. Map the pattern of unscheduled healthcare use by patients with 4 long term conditions over a 12 month period, and use the data to develop and test a 'red flag' system to identify potential, frequent users of unscheduled care. 3. Triangulate quantitative data with qualitative data about which user, service and family factors and social influences promote or deter unscheduled care in these conditions. 4.Develop and evaluate a pragmatic and effective patient-focused intervention which supports and enhances current service delivery, whilst reducing demand for unscheduled care. The intervention will be tested in terms of its value, acceptability and credibility to service users and other stakeholders, impact upon services, service implications and cost effectiveness. Research Team The research team includes internationally recognised researchers with expertise in applying, and integrating, quantitative and qualitative aspects of mental health research in the context of physical disease. We include a senior manager from the PCT in Manchester and have included user involvement from its inception. Research Environment This programme unites our research collaborations and academic links between the NHS (Manchester Mental Health and Social Care Trust, and Manchester Primary Care Trust) and the Universities of Manchester and Liverpool. We have a strong track record in Applied Health Services Research. Our local PCT has already supported this project by investing £25,000 for a research fellow to begin preliminary work including scoping literature reviews, and searching local databases for contact data. Outputs 1. A focussed and systematic synthesis of the psychosocial drivers which contribute to unscheduled care in patients with long term conditons, and interventions or strategies to reduce the frequency of unscheduled care. The synthesis will included associated costs and outcomes. Yr 1. 2. A robust 'red flag' system to identify patients with longterm conditions who are at risk of becoming frequent users of unscheduled care, which is generalisable across England. Yr 3-5. 3. A detailed description and full understanding, of who accesses unscheduled care, why they do this, what they experience, and what happens to them. Yr 3. 4. Identification of key cost elements that can be influenced by new interventions to reduce unscheduled care. Yr 3. 5. Development of a credible effective intervention which reduces unscheduled care whilst improving or maintaining patient benefit. Yr 5. 6. Modelling of health economic profiles of changes to service delivery and cost imputations of specific interventions which reduce unscheduled care. Yr 5. Public Involvement Our programme ensures user involvement at all stages and will build strong research-community partnerships.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;RESPIRATORY;METABOLIC AND ENDOCRINE;CARDIOVASCULAR