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Long-term conditions: the dynamics of quality

Published: 17 April, 2015

As my youngest son reaches his 23rd birthday, an age at which his grandfather was serving on the Arctic convoys, some research from the English Longitudinal Study of Ageing has caught my eye.

Looking at a cohort of over 16,000 patients in England aged 50+, with one or more of four common Long Term Conditions a newly published study found that many people were still not receiving the care they needed – with little change over 6 years (from 2004/5 to 2010/11).

The researchers viewed quality by looking at the % of quality indicators for healthcare received by participants – using 7 evidence-based standards for cardiovascular disease, 3 for depression, 5 for diabetes and 4 for osteoarthritis, and condition-level quality indicator achievement, including achievement of a bundle of 3 diabetes indicators.

Key points

  • The conditions considered were – cardiovascular disease, depression, diabetes and/or osteoarthritis.
  • The relatively high prevalence of specific illness burden in poorer participants was not matched by an equally high prevalence of diagnosis or treatment. It seems like barriers to equity may exist at the stage at diagnosis. The bottom line is that poorer people may be less likely than wealthier people to receive a diagnosis.
  • People with a diagnosis were generally equally likely to get good-quality care.

There is some interesting detail and differences tucked away in the findings. It is certainly worth noting, for instance, that while there were no types of people who consistently missed out on care, people with cognitive impairment received worse care for diabetes. Oh – and diabetes indicator achievement was better in those living alone.

In 2010/11 the achievement of evidence-based indicators was –

  • 84.2% for cardiovascular disease. Interestingly, hypertension care was better for those aged over 74 years
  • 59.8% for depression
  • 76.5% for diabetes – and achievement of the diabetes care bundle indicators was 70.9%.
  • 35.6%for osteoarthritis – and within this care was better for those with severe pain (vs. mild pain), limiting illness and obesity

You might want to check out the detail of these stats for yourself, to consider what lies behind them, and the implications for practice.

Source: Hardcastle, A.C.  et al. The dynamics of quality: a national panel study of evidence-based standards. Health Services and Delivery Research. 3(11) April 2015

Sue Lacey Bryant
Sue.LaceyBryant@hee.nhs.uk
CPD Tutor, Health Education Thames Valley

Last updated: 21 May, 2018

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