Why doctors should run re-enablement services Richard Day • Short term: avoid admission • Medium: avoid loss of independence • Long term: avoid institutionalisation Richard Day - BGS Spring 2009 Objectives Richard Day - BGS Spring 2009 • A hospital ward has a surface tension Richard Day - BGS Spring 2009 The surface tension of a hospital • It takes energy to free the patient from this grip • Secondary better – focus for special interest easier team working broader picture more committed to success? Richard Day - BGS Spring 2009 Primary vs secondary care • Public need • Technical skill • Body of knowledge Richard Day - BGS Spring 2009 What is a specialty Richard Day - BGS Spring 2009 Public Need (5QN) Bournemouth And Poole PCT 0 5000 10000 15000 20000 25000 Age-Standardised Rates Females 2005 Age-Standardised Rates Males 2005 30000 Richard Day - BGS Spring 2009 Emergency Hospital Admissions by PCT 2005 Percentage of total population 30 25 20 15 10 Bournemouth UA 0-19 years Bournemouth UA 65+ years Poole UA 0-19 years Poole UA 65+ years 5 0 2006 2012 2018 2024 2030 Richard Day - BGS Spring 2009 Population projections for Bournemouth and Poole, showing proportions of 0 to 19 and over 65 year age groups 2006 to 2030 Richard Day - BGS Spring 2009 Technical Skill Richard Day - BGS Spring 2009 Skills of a community geriatrician Years of medical/research/admin training • Make a diagnosis • Make decisions (eg when not to treat) • Communicate the decision Richard Day - BGS Spring 2009 Body of Knowledge Spice CL, Age and Ageing 2009 • Primary=nurse; secondary=doc+team • OR falls 0.52 vs primary care • Principle difference in intervention: medication changes (4% vs 52%) Richard Day - BGS Spring 2009 Primary vs Secondary Care in Prevention of Falls Citations on PubMed • • • • • • Re-enablement: 3 Re-ablement: 7 Admission avoidance: 234 Community geriatrics: 1825 Rehabilitation: 258398 Home care: 484420 Richard Day - BGS Spring 2009 What is the Science? Richard Day - BGS Spring 2009 Local services • East Dorset re-ablement services: PICS, CART, PINC, CLIC, REACT. • Local may be best • But how to compare efficacy, value for money. • • • • • • • • • • • • Medicine for the elderly Geriatric medicine Care of the elderly Elderly care Integrated medicine Elderly care medicine Geriatrics Elderly services Health care of the elderly Health care of older people Medicine for older people Medicine for elderly people • • • • • • • • • • • • Richard Day - BGS Spring 2009 What do we call geriatrics? Integrated medicine for the elderly Special responsibility for the elderly Age related medicine Adult medicine Care of older people Care of the elderly medicine Medical services for elderly people Medical services for older people Elderly Medical health care of the elderly Integrated general medicine Medicine of the elderly BMJ 2004 Richard Day - BGS Spring 2009 Conclusion • BGS Conferences show what we can do • • • • We work best as a team Decision maker leads the team The doctor makes decisions The doctor should lead the team