title: A before and after study of the impact of Specialist Workers for Older People.
abstract: 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, coordinate 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 GP 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.
authors.affiliation: Stroke Prevention Programme Manager, Professor of Primary Care Stroke Research, Department of Primary Care and General Practice, Clinical Sciences Building, University of Birmingham, Edgbaston, Birmingham, UK. k.fletcher@bham.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Fletcher
authors.forename: J
authors.initials: J
authors.lastname: Mant