HIRANI Shashivadan Parbati, et al
Background: Home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care.
Design: A study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities. General practice (GP) was the unit of randomisation and TC was compared with usual care (UC).
Methods: Participant-reported outcome measures were collected at baseline, short-term (4 months) and long-term (12 months) follow-up, assessing generic HRQoL, anxiety and depressive symptoms. Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed questionnaire measures at baseline assessment plus at least one other assessment (n = 873).
Results: Analyses found significant differences between TC and UC on Short Form-12 mental component scores (P < 0.05), with parameter estimates indicating being a member of the TC trial-arm increases mental component scores (UC-adjusted mean = 40.52; TC-adjusted mean = 43.69). Additional significant analyses revealed, time effects on EQ5D (decreasing over time) and depressive symptoms (increasing over time).
Conclusions: TC potentially contributes to the amelioration in the decline in users’ mental HRQoL over a 12-month period. TC may not transform the lives of its users, but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC.
This study estimates the economic benefits to commissioners of both health and social care across six British Red Cross schemes, two covering A&E hospital schemes, and four focused on community and individual resilience. Based on analysing these six schemes, BRC is found to be delivering substantial savings to health and social care commissioners, ranging from £168 to £704 per user relating to a rate of return between 40 to 280 per cent. Savings are realised through the prevention of hospital admission or reduced length of stay in hospital; reduced levels of hospital readmission; and preventing or minimising the use of expensive domiciliary and residential care. All the BRC schemes across the UK are estimated to have the potential to save commissioners £8m. This saving implies an overall return of 149 per cent on commissioner expenditure, suggesting that these schemes deliver material benefits and form a crucial element of care in the UK. In addition to savings there are a number of further benefits the schemes deliver, including service user benefits, signposting and assistance with access to additional services, reduction of social isolation and greater independence and wellbeing through the use of volunteers.
JOY Sarah, CORRAL Susana, NZEGWU Femi
An evaluation of the British Red Cross Support at Home services, which provide time-limited care and support to people at a time of crisis who are finding it difficult to cope at home. Overall the research highlighted that the common area of major impact of Support at Home is the enhancement of service users’ quality of life. The support provided is characterised by a strong sense of trust by service users in the Red Cross brand alongside a compassionate, caring, non-judgemental, time-flexible and person-enabling approach. In particular, the findings show that four service user outcomes were significantly improved or increased following receipt of support. These include: improved wellbeing; increased ability to manage daily activities; increase in leisure activities; and improved coping skills. Other positive changes were also reported related to the wider benefits of the service beyond the service user outcomes alone, including enabling safe discharge, supporting carers and enabling patient advocacy. The report identifies a series of action points to help further develop the services: champion Red Cross strengths, respond to the changing profile of service users, develop active partnerships to extend reach and maximise impact, clarify the Red Cross’ position for people in need who fall outside of commissioned contracts, collect consistent and routine local and national data to inform service learning and development, develop signposting to ensure long-term impact and grow skills in order to advocate on behalf of service users.