In England, a large portion of the population is not receiving adequate basic care from the National Health Service and private healthcare systems, especially older and weaker people, according to a study released on August 15, 2008 in BMJ.
As the populations in developed countries such as England become collectively older, health coverage issues for seniors and older adults are becoming increasingly important. Geriatric conditions may be higher in this population, which include falls, osteoarthritis, urinary incontinence, vision problems (cataract), hearing problems, and osteoporosis.
To understand the overall care of this older population, a research team from the University of East Anglia examined the quality of care given to 8,688 patients aged 50 or over with serious health conditions, to investigate whether effective healthcare interventions were received. Examination was conducted using a combination of questionnaires, interviews, and a set of quality of care indicators, used for both public and private care as part of the English Longitudinal Study of Aging (ELSA). This included specific examination of 13 different health conditions including heart disease, diabetes, stroke, depression and osteoarthritis.
Upon analysis, the authors concluded that only 62% of the recommended care for older adults is actually received. That is, of 19,082 potential opportunities for care delivery, only 11,911 actually were received by the patients. This varied drastically depending on health conditions. for instance, 83% of patients with ischaemic heart disease received the recommended care, a relatively high rating in contrast with the 29% of osteoarthritis patients who received appropriate treatment.
This attention rate was higher for screening and preventative care, at 80%, than for treatment and follow-up, with 64%, both of which were higher than diagnostic care at 60%. Notably, some medical conditions merit additional awards when addressed by general practitioners under the current Quality and Outcomes Framework: these were generally better attended. In 75% of applicable cases, correct treatment was administered, but this was true for only 58% of conditions not covered in this contract.
Disability and frailty related conditions were the least attended to in this context. General medical conditions received substantially more consistent care, at 74%, while geriatric conditions only achieved 57% of the recommended care. This is notable in the context that there are no geriatric conditions included in the aforementioned framework contract. According to the researchers, improvement will best be achieved through initiatives to improve quality for chronic conditions that affect older people. They suggest that restructured payment schemes for general practitioners might be one effective approach to achieve this.
Professor Bruce Guthrie from the University of Dundee contributed an accompanying editorial that focuses on the local interventions needed for improvement of care.
Self reported receipt of care consistent with 32 quality indicators: national population survey of adults aged 50 or more in England
Nicholas Steel, Max Bachmann, Susan Maisey, Paul Shekelle, Elizabeth Breeze, Michael Marmot, David Melzer
BMJ 2008;337:a957
doi:10.1136/bmj.a957
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Written by Anna Sophia McKenney