An inner city GP unit versus conventional care for elderly patients: prospective comparison of health functioning, use of services and patient satisfaction

Background. GP units are generally nurse-led wards, where GPs have direct a dmitting rights and retain clinical responsibility for their patients. Whil e Gf-led wards are not new, they are relatively uncommon in urban areas. In addition, there has been little comparative evaluation of this type of ser vice. Objectives. The aim of the present study was to compare patients admitted t o an inner city GP unit with comparable patients in conventional care (e.g. district nursing, nursing/residential homes, acute care of the elderly war ds) in terms of mental and physical functioning, use of health and social s ervices and patient satisfaction. Methods. Study group patients were those admitted to the GP unit; compariso n group patients were identified by GP practices or conventional services w ho had agreed to participate in the study. Suitable patients were aged 65 y ears or over and fitted the eligibility criteria for the GP unit. Patients were interviewed at th me time points: admission to either the GP unit or c onventional care, and at 1 and 3 months after admission. Baseline comparabi lity was assessed by demographic and medical data, cognitive function, ment al state, social support, use of health and social services, and mental and physical functioning (SF-12). Mental and physical functioning and use of h ealth and social services were compared between the groups over time. Patie nt satisfaction with their care was also compared between groups. Results. Change in the mental and physical functioning between patients on the GP unit (n = 67) and those in conventional care (n = 60) did not differ when the groups were compared at any of the three time points. However, th e mental function of patients in the GP unit significantly improved between admission and 1 month after admission (P < 0.05). This effect was not sust ained at 3 months after admission. GP unit patients were consistently more positive about the care they received than patients receiving conventional care; this included communication and information, staff, care and the faci lities. Both groups of patients were high users of health and social servic es, with similar patterns of use in both groups, which did not alter over t ime. Conclusions. Patients who received care on the GP unit experienced a simila r physical outcome to patients in conventional settings; however, they appe ared to enjoy a short-term improvement in mental functioning and were consi stently more positive about the quality of their care. This study has impor tant policy implications with regard to planning future intermediate care s ervices and will be of particular interest to health service planners and t hose responsible for clinical governance.