25 / 09 / 2018
Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions
The Health Foundation, August 2018
This report from the Health Foundation looks at the importance of supporting patients to manage their health conditions, highlighting new findings on the relationship between a patient’s ability to manage their health condition and their health care utilisation across primary and secondary care, including emergency hospital admissions.
The findings show that the ability of patients to manage their health conditions has the potential to affect every part of the health service, but suggests that the biggest opportunity to reduce avoidable hospital use lies in urgent care
The paper reveals that over the past 12 years, the number of emergency hospital admissions in England has increased by 42%, from 4.25 million in 2006/07 to 6.02 million in 2017/18 and that over 60% of the patients admitted to hospital as an emergency have one or more long-term health conditions.
The Health Foundation looked at Patient Activation Measure (PAM) scores, to find out how able patients currently feel to manage their health conditions, this assesses four levels of knowledge, skill and confidence in self-management, for over 9,000 adults with long-term conditions. They found that 13% of patients reported the highest level of ability in managing their health conditions, but almost a quarter reported the lowest level. The results showed that those patients who were most able to manage their health conditions were far less likely to use health services.
They had 38% fewer emergency admissions than the patients who were least able to. They also had 32% fewer attendances at A&E, were 32% less likely to attend A&E with a minor condition that could be better treated elsewhere and had 18% fewer general practice appointments.
Looking at mental health conditions, the results showed that those patients most able to manage a mental health condition, as well as any physical health conditions, experienced 49% fewer emergency admissions than those who were least able.
The report concludes that these results indicate that the NHS could reduce avoidable use of health services, including the number of emergency admissions and A&E attendances, by better supporting patients to manage their own health conditions and that this could have significant impact on the demand for NHS services.
The paper suggests that potentially, if those currently least able to manage their conditions were better supported, so that they could manage their conditions as well as those most able, it could lead to 436,000 fewer emergency admissions, a 7% a year decrease in the total across England and 690,000 fewer attendances at A&E, which would be 6% decrease.
Significantly, the research indicates that even if the patients who are currently least able to manage their conditions could be supported to manage their health conditions only as well as those at the next level of ability, this could prevent 504,000 A&E attendances, and 333,000 emergency admissions per year.
The briefing assesses the evidence for the effectiveness of a range of approaches the NHS could use more often to support patients to manage their health conditions. These include: health coaching, self-management support through apps, social prescribing initiatives and peer support including via online communities.
The paper concludes that there are concerns that supporting patients to manage their own health care might be neglected because of the pressures facing the NHS. Overall, the paper recommends that national and local decision makers do more to understand people’s ability and, implements approaches to supporting people so that they have the ability and confidence to manage their long-term conditions.