A before and after study of the impact of Specialist Workers for Older People.
BACKGROUND
Case management of vulnerable older people by Community Matrons has been introduced into the UK. A locally designed case management approach, the Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here, we report an evaluation of this service.


METHODS
Before and after study of 418 people (207 before; 211 after) aged >or=75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, co-ordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload.


RESULTS
There was a non-significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine general practitioner surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001).


CONCLUSIONS
Case management might reduce hospital admissions and is potentially a cost-effective service. However, not all case management schemes are successful. With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.
Fletcher
K
K
Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK. k.fletcher@bham.ac.uk
Mant
J
J
D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000458:organization & administration*; D003153:Community Health Services; D003365:Costs and Cost Analysis; D004739:England; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006779:Hospitals, Public; D006801:Humans; D020380:Needs Assessment; D017060:Patient Satisfaction; D011320:Primary Health Care; D013038:Specialization; D013222:State Medicine