EXECUTIVE SUMMARY
1. 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.
2. 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.
3. 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
4. Significant gaps in the evidence available were identified. The major ones are as follows.
In relation to shifting the focus of care:
- The potential of preventative and assessment-based interventions
In relation to shifting the location of care:
- The important role the provision of suitable housing (including housing with care or support) can play in sustaining people in the community
In relation to changing roles:
- The impact on carers of shifting the balance of care.
- The role of social workers and unpaid carers - especially in relation to long term care and end of life services.
5. The gaps in evidence identified in this review do not mean that other work contributing to a shift in the balance of care is not being conducted. However the time-limited review carried out here and the broad search terms used means that this work was not necessarily captured.
6. Much of the evidence included in the review is international in nature, with 16 Scottish studies identified as meeting the quality and relevance review criteria. The review may, though, provide the high level context for further work, using different search criteria, identifying and reviewing the findings of Scottish or UK research in specific service areas.