Multimorbidity and access to social Care: exploiting emerging administrative data sources in Scotland.

Abstract

Introduction
Integration of health and social care services is a potential solution to improving care despite budgetary constraints and increased demand for services. Little is known about how having two-or-more long-term conditions (multimorbidity) and socioeconomic status affect social care use, or how all these factors affect unscheduled health care use.

Objectives and Approach
The project aims to describe the demographic, geographic, and socioeconomic differences in the receipt of social care for over 65s in Scotland and how multimorbidity status influences amounts of social care received. Additional analyses will consider the influence receipt of social care has on use of unscheduled health care services and mortality.

Social Care Survey (SCS) data collected by the Scottish Government is linked to administrative health and mortality records. Linkage includes; prescribing information service and USC data which records episodes of A & E attendance, emergency admission to hospital, GP out-of-hours attendance, Scottish Ambulance Service use, and NHS24 contact

Results
The cohort includes 1.1million individuals over the age of 65 (54.8% Female), of which 274,011 (24.2%) people died during the study period.

The linkage rate of the SCS to records with a CHI number in the National Records of Scotland population spine was 90.5%, with one local authority removed for very low linkage rates and the remaining 31 with rates between 76.7% and 97.9%.

As of February 2018, all requested data has been transferred to the National Safe Haven and data cleaning and analysis has begun. Significant results are expected to have been produced by August 2018.

Conclusion/Implications
This research will help understand if receipt of social care is equitably distributed among the population of Scotland after allowing for multimorbidity and socioeconomic status. Understanding the influence health status has on social care receipt and the influence social care has on unscheduled healthcare use has important implications for policy development.

Introduction

Children who have been in out-of-home care have faced significant issues during their lives, and they are considered one of the most vulnerable groups in society. Given the limited evidence in Western Australia about outcomes for care-leavers, this study represents a base line for future studies of care-leavers outcomes.

Objectives and Approach

A retrospective cohort study exploring the outcomes for young people born between 1990-1995, who have reached at least 18 years of age and have had a period of care, compared to other similar children in WA. This project used administrative linked data from the Department of Communities Child Protection and Family Support Division, Departments of Health, Education, and Corrective Services. This study undertook a descriptive approach to compare outcomes for young people who have left out-of-home care, and logistic regression modelling to explore the odds of having poorer outcomes among those who had a period in care.

Results

Young people aged 18 years and over who had been in out-of-home care had worse outcomes compared to controls. Care-leavers had nearly twice the hospital admission rate of those who never had contact with the child protection system, almost three times more likely to have a mental health related contact, less likely to achieve a high school completion certificate and attend University, and more likely to have a juvenile community sentence or adult detention.

A group of young people who had a period in care were identified as more likely to have ‘poorer outcomes’ compared to the rest of the Care group if they: were Aboriginal; female; born in a more disadvantaged area; and first entered care after the age of 10.

Conclusion/Implications

Young people who have been in care are at high risk of a range of poor outcomes, even compared to other children who have experienced similar disadvantage. Regardless of the causes, it is incumbent upon the State as acting ‘parents’ to provide the best possible support to improve their outcomes.