Anticipatory Care Series: Anticipatory Care Matters
Professor Anne Hendry is Honorary Secretary of the BGS. Her enduring passion for high quality healthcare for older people spans more than 25 years as consultant geriatrician/stroke physician with an interest in intermediate care and specialist support closer to home. Her current support for the European Joint Action on Frailty has increased her professional and policy networks on ageing across the UK and in Europe. As a Senior Associate for the International Foundation for Integrated Care she often coordinates study visits and webinars on integrated care for older people. She tweets @AnneIFICScot. Follow all the tweets via #BGSAnticipatoryCare
I was pleased to represent BGS on NHS England’s Clinical and Professional Reference Group for Anticipatory Care. There was some debate about the term Anticipatory Care but a consensus that people living with frailty or multiple complex conditions need proactive care and support to stay independent and healthy for as long as possible at home or the place they call home. Anticipatory Care represents a shift from reactive, fragmented, episodic care to personalised community-based coordinated care that starts with what matters to the individual and takes an enablement and strength-based approach.
With developments in the electronic frailty index and ready access to population health data, we can more easily identify people at greatest risk of adverse outcomes and offer earlier intervention. There’s no shortage of evidence about what support and treatments can be offered, as nicely summarised in NHS England’s recent Anticipatory Care Interventions Framework.
Dr. Liz Lawn describes the professional pride she has drawn from working with a proactive, holistic team. We have many emerging beacons of good practice that show benefits for patients, carers and professionals. NHS England hosts an Anticipatory Care Community of Practice for professionals from all disciplines. I would encourage BGS members to join this online forum, particularly our Community and Primary Care group members who are involved in Anticipatory Care across the UK.
My favourite international example is ProPCC: a primary care led programme in the Metropolitana Nord area of Barcelona. The team co-designed their model with patients as described in this publication. Weekly multidisciplinary team meetings (MDTs) in primary care identify patients with complex needs and review their care plans; fortnightly community MDTs bring together Primary care, intermediate and palliative care teams to review care plans for those who are deteriorating, agree interventions together and discuss with local hospitals colleagues prompt access to diagnostics and specialist decision-making. Comparing healthcare use for over 1000 patients in the six months before and after they entered the programme, they observed a 28% reduction in Emergency Department visits, 27% reduction in hospital admissions and 4% increase in the number of days spent at home. I’m looking forward to hearing more from the team at EuGMS!
As Professor Adam Gordon explains, most studies of anticipatory care report improved care coordination and experience but little impact on hospital demand. Why does this example from Barcelona buck the trend? I’m convinced the answer lies in the way the programme was integrated across their system. The Care Well project in eight European regions also reported encouraging results in terms of reducing emergency hospital attendances. Last year a paper from Sweden reported reduced need for hospital care following primary care based CGA in a high-risk population of older adults.
So we are seeing emerging academic evidence to support Anticipatory Care as a global priority in this Decade of action on Healthy Ageing. As we recover from the pandemic there has never been a better time to shift the dial to prevention and earlier intervention. So why are we not rolling out Anticipatory Care further and faster?!
The adoption challenge is how pressurised primary care teams can create the bandwidth to have collaborative multidisciplinary conversations about people whose health, functional ability or social circumstances are changing and, as Dr Deb Gompertz describes, involve partners from housing, community and voluntary sectors who provide great support for self management and wellbeing. Care coordination also needs excellent communication skills and an ability to connect and share information with all who contribute to assessment, treatment, rehabilitation, and long term care and support. Our IT systems are not there yet!
Anticipatory care is the essence of integrated care as described by National Voices - My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes.
If Integrated Care Systems are to deliver on their aim, they must invest in creating capacity, time and space for professional disciplines to work together to make Anticipatory Care a reality. Coming together around Anticipatory Care will generate precious experiential learning and capability for integrated care across the system. Postgraduate leads should make sure trainees engage with locality teams to understand their future contribution to Anticipatory Care.
We should evaluate implementation by measuring the benefits in terms of personal, professional, team and system outcomes. And let’s not forget the social value as described in Jennifer Farren’s poignant blog. What do you think the social return on investment would be from the life-changing Anticipatory Care for Ethel?
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