The 2-year costs and effects of a public health nursing case management intervention on mood-disordered single parents on social assistance.
OBJECTIVE
This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.


METHODS
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.


RESULTS
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.


CONCLUSIONS
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
Markle-Reid
Maureen
M
System-Linked Research Unit on Health and Social Service Utilization, School of Nursing, McMaster University, Room 3N46, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. mreid@mcmaster.ca
Browne
Gina
G
Roberts
Jacqueline
J
Gafni
Amiram
A
Byrne
Carolyn
C
D000223:Adaptation, Psychological; D000328:Adult; D019090:Case Management / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D003866:Depressive Disorder / Q000191:economics / Q000451:nursing* / Q000534:rehabilitation; D004651:Employment; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009864:Ontario; D011632:Public Assistance; D011637:Public Health Nursing / Q000191:economics*; D015406:Single Parent / Q000523:psychology*; D012917:Social Adjustment