title: Increased use of emergency services by older people after health screening.
abstract: BACKGROUND
  evaluation of the 'Keep Well At Home' (KWAH) Project in West London indicated that a programme of screening persons aged 75 and over had not reduced rates of emergency attendances and admissions to hospital. However, coverage of the target population was incomplete. The present analysis addresses 'efficacy'-whether individuals who completed the screening protocol as intended did subsequently use Accident & Emergency (A&E) services less often.
  
  
  METHODS
  the target population was divided into five groups, depending on whether an individual had completed none, one or both phases of screening, and whether deviations from the protocol related to incomplete coverage or refusal to participate further. We ascertained use of emergency services before screening and for up to 3 years afterwards by linkage of records from KWAH to those of local A&E Departments. Patterns of emergency care were examined as crude rates and, via proportional hazards models, after adjustment for available confounders.
  
  
  RESULTS
  there was an increase of 51% (95% CI 22-86%) in the crude rate of emergency admissions in the year after first-phase screening compared with the 12 months before assessment. This was most obvious in individuals deemed at high risk who also underwent the second-phase assessment (adjusted hazard ratio relative to individuals not 'at risk'=2.33; 95% CI 1.59-3.42).
  
  
  CONCLUSIONS
  the available data do not allow us to distinguish between several possible explanations for the paradoxical increase in use of emergency services. However, what seem to be sensible policies do not necessarily have their intended effects when implemented in practice.
authors.affiliation: Department of Primary Care and Social Medicine, Imperial College, London, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Walker
authors.forename: Konrad
authors.initials: K
authors.lastname: Jamrozik
authors.forename: David
authors.initials: D
authors.lastname: Wingfield
authors.forename: Guy
authors.initials: G
authors.lastname: Lawley
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D008403:Mass Screening; D008498:Medical Record Linkage