Exposure to case management: relationships to patient characteristics and outcome - Report from the UK700 trial

TY - JOUR

T1 - Exposure to case management: relationships to patient characteristics and outcome - Report from the UK700 trial

AU - Burns, T

AU - White, I

AU - Byford, S

AU - Fiander, M

AU - Creed, F

AU - Fahy, T

PY - 2002/9

Y1 - 2002/9

N2 - Background Trials in community psychiatry must balance rigour with generalisability. The UK700 trial failed to find a significant effect on hospitalisation, but its sample population contained significant heterogeneity of exposure to case management in the two groups. Aims To test whether patients successfully exposed to a minimum of 12 months' intensive case management over the 2-year follow-up period achieved reduced hospitalisation. Method Of 679 participants with hospitalisation data, 84 were identified as having <12 months' exposure owing to prolonged hospitalisation, imprisonment or a combination of the two. These patients were excluded and outcomes tested for the remaining 595 patients. Results Overall reduced case-load size did not reduce hospitalisation or treatment costs over 2 years despite elimination of outliers. Age, previous hospitalisation and source of recruitment to the study all correlated with outcome. Conclusions Case-load reduction is not in itself enough to reduce the need for hospital care in psychosis. Baseline patient characteristics (in particular length of previous hospitalisation and recruitment from in-patient care) have a significant influence and should be allowed for in power calculations. Identifying the optimal clinical profile for patients likely to benefit from intensive case management remains a pressing need for further studies. Declaration of interest None.

AB - Background Trials in community psychiatry must balance rigour with generalisability. The UK700 trial failed to find a significant effect on hospitalisation, but its sample population contained significant heterogeneity of exposure to case management in the two groups. Aims To test whether patients successfully exposed to a minimum of 12 months' intensive case management over the 2-year follow-up period achieved reduced hospitalisation. Method Of 679 participants with hospitalisation data, 84 were identified as having <12 months' exposure owing to prolonged hospitalisation, imprisonment or a combination of the two. These patients were excluded and outcomes tested for the remaining 595 patients. Results Overall reduced case-load size did not reduce hospitalisation or treatment costs over 2 years despite elimination of outliers. Age, previous hospitalisation and source of recruitment to the study all correlated with outcome. Conclusions Case-load reduction is not in itself enough to reduce the need for hospital care in psychosis. Baseline patient characteristics (in particular length of previous hospitalisation and recruitment from in-patient care) have a significant influence and should be allowed for in power calculations. Identifying the optimal clinical profile for patients likely to benefit from intensive case management remains a pressing need for further studies. Declaration of interest None.

UR - http://www.scopus.com/inward/record.url?scp=0036729551&partnerID=8YFLogxK

U2 - 10.1192/bjp.181.3.236

DO - 10.1192/bjp.181.3.236

M3 - Article

SN - 1472-1465

VL - 181

SP - 236

EP - 241

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - SEPT.

ER -