Hospital Admissions from Care Homes - Assignment Example

?The qualitative study carried out by Briggs has inferred that owing to the Local Enhanced Service (LES), the hospital admissions from care homes have been reduced and also that the inhabitants of LES-supported care homes have better access to and better quality health care services. Conducting a study in a London Borough, which comes under a single Primary Care Trust (PCT), the researcher arrives at this conclusion. The findings from this study have been projected as applicable to the whole context. The methodology that was followed in this research included 30-minute telephonic and face-to-face interviews of GPs, and care home professionals and face-to-face interviews with care home residents and their family members (Briggs, 2011, p.5-6). The sample sizes of GPs and care home professionals were 3 and 8 respectively. Sample sizes of care home residents and family members were 23 and 2 respectively. On introspection from an academic researchers’ point of view, these sample sizes leave some ambiguity regarding the procedure adopted in selecting the sample. The researcher has not clarified which scientific method of sampling was adopted in selecting this sample. This raises a doubt about the authenticity and validity of this study. One definition of validity in research is that “we have reached the goal of validity when our statements or conclusions about empirical reality are correct” (Engel and Schutt, 2005, p.18). This research exercise is ambivalent, when considered from the angle of “measurement validity, generalizability, and causal validity,” which are the three aspects of validity as far as social science research is concerned (Engel and Schutt, 2005, p.19). This is so because no proper measurement has been made by this research exercise, it has very limited generalizability because of the erratic sampling and also the cause of change has not been properly identified in terms of dependent variables other than the adoption of LES. There could be locally specific and institution-specific causal factors. Another matter of concern is that the sample size seems to be too small to be in agreement with the existing social science research norms. It has been observed, “you would need a very large sample in order to have a chance of finding an impact of social work” (Gorard, 2003, p.61). Though this notion has been somewhat changed after approval for qualitative research with smaller sample sizes grew, the extremely small sample size (with no consistency while selecting respondents from each category) in this research limits its scope of application to the narrow geographical area in which it is conducted. And it has to be reminded, “by convention, […] thirty comprises the magic number for the allowable minimum sample size” (Seidman, Seidman and Abeyesekere, 2001, p.174). In this research, it can be seen that no sample from any of the categories of respondents chosen by the researcher meets this criteria. The researcher has said that, the “interviews were […] open-ended and required participants to reflect on their general experiences of GPs and the ease of accessing support, and comment on any improvements to the service” (Briggs, 2011, p.6). Though open-ended questions are more suitable for small sample sizes, it has to be remembered, “open-ended questions are far more difficult to code” (McNabb, 2010, p.118). The researcher in this particular study has not given any information on the data collection procedure and also the coding of the data thus collected. This has badly affected the credibility of this study. At the same time, the research has fulfilled the ethical conditions required in such a venture, by following the “established procedures” as prescribed by the British Sociological Association (Briggs, 2011, p.6). The researcher has maintained transparency by admitting that the “review [that was carried out] was not commissioned as research and therefore ethical approval was not required” (Briggs, 2011, p.6). The erratic methodology of this academic exercise is justified by this admission that this is a review rather than a purely academic and scientifically done research. Two major drawbacks of this study are listed by the researcher- he remarked, “some GPs did not respond to the request for interview (n=4) and some residents found it difficult to reflect on their experiences (in particular those with dementia)” (Briggs, 2011, p.6). The major group of respondents in terms of sample size were the care home residents but “dementia prevalence within care homes is estimated at 62%” (Hughes, Lloyd-Williams and Sachs, 2010, p.181). With such an enormous rate of occurrence of dementia, the ability of a care home resident to factually report opinions and memories is highly questionable. This can negatively affect the validity of this review’s findings. The findings are summarised into three “main themes of current practice” by the researcher, namely, “current working relationships and communication; service efficiency; and residents’ experiences” (Briggs, 2011, p.6). The major and general conclusion made is that LES has enhanced the quality of service accessed by care home residents by promoting “positive working relationships” in the field of care, which is again brought about by better communication at various levels (Briggs, 2011, p.6). Though the researcher (Briggs, 2011) has argued that LES brings about better communication among all parties concerned in this given research situation, he has not explained how. He (Briggs, 2011) also has not put forth any supporting evidence for this from his data sets. But considering the proclaimed status of this study attempt as a review rather than a scientific research, this venture can be viewed as an important step to give indications about the effectiveness of LES. From the questions asked to professionals regarding current service delivery, the cost involved in taking a patient to hospital and availing medical help there, was examined in comparison with the cost amounting to the money to be paid to the GP under the LES (Briggs, 2011, p.6). And it is delineated that the payment to be made to the GP under LES is far less than the cost involved with taking the patient to the hospital (Briggs, 2011, p.6). But the researcher (Briggs, 2011) has assumed that all the care homes in the area under study had to bear the same amount of costs for patient hospitalization (p.6). But this cost will necessarily depend on factors like the proximity of the hospital, the nature of the medical problem with the specific care home resident and also the facilities available at the particular hospital. Hence, to fix a common cost for all hospitalisations is problematic. It is also wrongly assumed that all PCTs opt for a common standard payment level for GPs. But the fact is that “payment levels for LESs will also be agreed locally and not necessarily on a national scale” (Charlton, 2005, p.60). But it can be generally assumed that there is of course a perceived reduction in costs, though not yet quantifiable. Another general criterion selected by the researcher (Briggs, 2011) to support his argument is a comparison between the numbers of deaths of care home inmates that happened in the care homes themselves, as compared to hospitals (p.6). It is shown that there is a reduction in the number of deaths that happened in hospitals after the introduction of LES (Briggs, 2011, p.6). But the possibility that the reason behind the increased number of deaths in care homes could be caused by simple neglect rather than medical care at home, go unaccounted here. Supporting testimonies of the people in the fields concerned, are also taken out of the research data collected, to specifically substantiate the conclusions. In a qualitative research paper like this, with very small and erratic sample size, it is very apt to have such personal quotations included. Such quotations are able to give the reader a general picture of on what basis the researcher has made his own subjective conclusions, (which is rather permissible in this kind of social research). But all the same, the researcher (Briggs, 2011) falls short of acknowledging the subjective quality and the presence of personal bias in his research. The works of qualitative researchers have been often criticised as being “unscientific, or only exploratory, or entirely personal and full of bias” (Outhwaite and Turner, 2007, p.580). But it has also to be kept in mind that “quotations in text […] [are] the most common format for presenting qualitative data” (Aral et al., 2007, p.461). The responses of care home professionals in this review also suggested that better working relationships were established under LES (Briggs, 2011, p.7). These working relationships were found manifesting in the form of “reduction in hospital numbers, better continuity of care for residents, and better monitoring measures” (Briggs, 2011, p.7). Also, the responses indicated better service efficiency (Briggs, 2011, p.7). The responses of care home residents and their family members stressed the newly found continuity of care as a major benefit of LES (Briggs, 2011, p.9). Continuity of care is of utmost importance from the interpersonal to the professional level, and is a requirement “to establish and then maintain a trusting therapeutic relationship” (Jones, 2004, p.267). The “level of care” that a GP gave them was also quite satisfactory for them, according to the study (Briggs, 2011, p.10). All these inferences made in this review are more or less in agreement with the purely academic studies carried out on the same topic. For example, Charlton (2005) has pointed out that LESs can be a very effective mechanism for giving patients “specialized services or treatments catering for a specific local need in primary care” (p.59). The system of LES is also in agreement with the National Service Framework for Older People, 2001, which says that “older people will have access to a new range of intermediate care services at home, or in designated care settings, to promote their independence by providing enhanced services” (cited by Roe and Beech, 2005, p.12). In this way enhanced local services is a matter of policy and practice, which needs to be strengthened. The review conducted by Briggs (2011) can be viewed as a positive step in understanding the realities, possibilities, and loopholes in the implementation of the same. References Aral et al., 2007. ‘Behavioral interventions for prevention and control of sexually transmitted diseases’, Springer, Berlin. Briggs, D March 2011. ‘Reducing hospital admissions from care homes: considering the role of a local enhanced service from GPs’, Working with Older People, Vol. 15, Issue 1. pp.4-12. Charlton, R. 2005. ‘The GP contract made easy: getting paid’, Radcliffe Publishing, Oxford. Engel, R.J. and Schutt, R.K. 2005. ‘The practice of research in social work, Volume 1’, SAGE, London. Gorard, S. 2003. ‘Quantitative methods in social science’, Continuum International Publishing Group, London. Hughes, J.C., Lloyd-Williams, M. and Sachs, G.A. 2010. ‘Supportive care for the person with dementia’, Oxford University Press, Oxford. Jones, R. 2004. ‘Oxford textbook of primary medical care, Volume 1’, Oxford University Press, Oxford. McNabb, D.E. 2010. ‘Research methods for political science: quantitative and qualitative approaches’, M.E.Sharpe, New York. Outhwaite, W. and Turner, S.P. 2007. ‘The SAGE handbook of social science methodology’, SAGE, London. Roe, B.H. and Beech, R. 2005. ‘Intermediate and continuing care: policy and practice’, Wiley-Blackwell, London. Seidman, A.W., Seidman, R.B. and Abeyesekere, N. 2001. ‘Legislative drafting for democratic social change: a manual for drafters’, Kluwer Law International, London. Read More