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Sunday, December 30, 2007

Risk: Triangles that Trip [ack. Siegel, HSJ 20 Dec. p.23]

Happy holidays to one and all! Your interest is greatly appreciated.

In last weeks HSJ Matt Siegel's Data Briefing featured Missing pieces of the emergency plan, the focus was the risk relative to the population average of emergency admission, outpatient and A&E visits for specific intervention groups.

One of the figures comprised a pyramid which lists the intervention strategies that aim to reduce these service contacts:

CASE
MANAGEMENT
[Very high relative risk]

DISEASE MANAGEMENT [High risk]
SUPPORTED SELF-CARE [Moderate risk]
PREVENTION AND WELLNESS PROMOTION [Low risk]

By pursuing case management of course we can reduce the number of people needing to visit or be admitted to health services. Siegel highlights that if efforts are limited to those at very high risk then we can only influence (at best) 10% of total emergency admissions.

I've been working quite closely with a community matron recently and this 10% are a worthy target, but looking at triangles there are two essential dimensions here. One concerns the 'ascent'. Although it usually takes time (and may even entail oxygen at home) we need to entertain people at base camp for as long as possible. Why?

Because when viewed in terms of the health career every one of us is a climber.

As the supported self-care and prevention labels reveal this is recognised and is very much a part of overall strategy - but; in the low-lands though, the fog can cloud our vision.

The other dimension also lies in the very structure of triangles. The sticky-out-bits: the feet - can trip you up. Siegel points out the need to intervene elsewhere; apparently for example, the two middle risk levels which account for 20% of the total population. In the saga of joined-up health and social care the value of day care for example seems lost in the debate about who/how it should be provided? I need to check the latest literature, but I thought the size and stability of an individual's social network is a key determinant in +ve mental health? Another research question relates to how the number of required day places is derived?

In looking to make changes in the towering heights, let's not forget the nitty-gritty of care on the ground.

It isn't just having these varied intervention programmes in place. It's about managing the traffic on the passes (now there's a subtle interface!). There are many communities out there and they are far from equal. Community care: define. ...

an·a·gram: triangle = alerting, altering, integral, relating

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