Shared patients: multiple health and social care contact

The paper describes results from the 'Tracking Project', a new method for e xamining agency overlap, repeat service use and shared clients/patients amo ngst social and health care agencies in the community. This is the first pr oject in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplin ary database for one county (n = 97 162 cases), through standardised anonym isation of agency databases, using SOUNDEX, a software programme. A range o f 20 community social and health care agencies were shown to have a large o verlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of m ajor overlap: 16.2% (n = 39 992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775 000) of t he total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a cha racteristic of community agency populations (n = 39 992) revealed that incr easing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients tha t repeatedly attend Accident and Emergency are much more likely to attend m ore other agencies, indicating the possibility that they share more problem atic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predicto rs from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggest ed that Accident and Emergency attendance might serve as an important predi ctor of multiple agency attendance.