Mai Stafford1, Sarah R Deeny2, Kathryn Dreyer2, Jenny Shand3,4,5. 1. The Health Foundation, London, UK mai.stafford@health.org.uk. 2. The Health Foundation, London, UK. 3. UCLPartners, London, UK. 4. Institute of Epidemiology & Health Care, University College London, London, UK. 5. Care City, Barking, UK.
Abstract
BACKGROUND: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multiple long-term conditions (MLTCs) is understudied. AIM: To test whether co-residence with a person with MLTCs (compared with a co-resident without MLTCs) is associated with utilisation and cost of primary, community, secondary health care, and formal social care. DESIGN & SETTING: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged ≥50 years in two-person households in 2016-2018. METHOD: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health, and social care by MLTC status of individuals and co-residents, adjusted for age, sex, and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink (CPRD). RESULTS: Forty-eight per cent of people with MLTCs in two-person households were co-resident with another person with MLTCs. They were 1.14 (95% confidence interval [CI] = 1.00 to 1.30) times as likely to have community care activity and 1.24 (95% CI = 0.99 to 1.54) times as likely to have mental health care activity compared with those co-resident with a healthy person. They had more primary care visits (8.5 [95% CI = 8.2 to 8.8] versus 7.9 [95% CI = 7.7 to 8.2]) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. CONCLUSION: Care utilisation for people with MLTCs varies by household context. There may be potential for connecting health and community service input across household members.
BACKGROUND: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multiple long-term conditions (MLTCs) is understudied. AIM: To test whether co-residence with a person with MLTCs (compared with a co-resident without MLTCs) is associated with utilisation and cost of primary, community, secondary health care, and formal social care. DESIGN & SETTING: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged ≥50 years in two-person households in 2016-2018. METHOD: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health, and social care by MLTC status of individuals and co-residents, adjusted for age, sex, and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink (CPRD). RESULTS: Forty-eight per cent of people with MLTCs in two-person households were co-resident with another person with MLTCs. They were 1.14 (95% confidence interval [CI] = 1.00 to 1.30) times as likely to have community care activity and 1.24 (95% CI = 0.99 to 1.54) times as likely to have mental health care activity compared with those co-resident with a healthy person. They had more primary care visits (8.5 [95% CI = 8.2 to 8.8] versus 7.9 [95% CI = 7.7 to 8.2]) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. CONCLUSION: Care utilisation for people with MLTCs varies by household context. There may be potential for connecting health and community service input across household members.
Authors: Therese Lloyd; Elizabeth Crellin; Richard James Brine; Julia Y Shen; Arne Timon Wolters Journal: BMJ Open Date: 2022-05-02 Impact factor: 3.006
Authors: Clare MacRae; Harry William Fisken; Edward Lawrence; Thomas Connor; Jamie Pearce; Alan Marshall; Andrew Lawson; Chris Dibben; Stewart W Mercer; Bruce Guthrie Journal: BMJ Open Date: 2022-10-03 Impact factor: 3.006