Overview of Evidence Relating to Shifting the Balance of Care:
A Contribution to the Knowledge Base
Lucy Johnston, Clare Lardner and Ruth Jepson
Scottish Government Social Research, 2008
Available online PDF [81p.] at: http://www.scotland.gov.uk/Resource/Doc/237140/0065049.pdf
“….This report presents the findings of a short review of evidence. The aim was to provide an overview of evidence to contribute to the debate on, and inform the development of, the policy on shifting the balance of care a key theme within health and community care policy which is intended to bring about improvements in service delivery and health outcomes.
Shifting the balance of care is a term used to describe change at a number of levels, for example, shifting the location of care towards more community-based facilities, shifting the focus of care towards long term conditions and changing the roles and responsibilities of patients and professionals.
The search for evidence identified 4,900 items. These were screened for relevance and quality and 601 items remained. Of these, 205 were high level evidence (e.g. systematic reviews) and are briefly summarised here. The remaining 396 primary research studies are mapped to indicate coverage of relevant topics and gaps in the evidence. All 601 studies included in the review can be found on the Shifting the Balance of Care website:
www.shiftingthebalance.scot.nhs.uk.
The high level evidence suggests that the following interventions could contribute to shifting the balance of care:
Shifting the focus of care via:
- Assessment of older people (especially as a prelude to case management)
- Multi- disciplinary working (less conclusive in relation to palliative care)
- Integrated care for older people, people with LTC, Alzheimer’s and people with HIV/AIDS
- Disease management (especially in relation to long term conditions)
- Early supported discharge with community-based rehabilitation for stroke and other patients
- Rehabilitation in the community for a range of conditions
Shifting the location of care via:
- Housing adaptations and equipment
- Supported discharge for older people and for people after a stroke
- Early supported discharge for older people and people after a stroke
- Care at home and hospital at home interventions
- Community hospitals
- Day hospitals
Changing roles via:
- Substitution of roles
- Respite and day care services to support unpaid carers
Shifting responsibilities via:
- Telephone support services
- Telephone consultation
- Self care support
- Self monitoring of long term conditions
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