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


OBJECTIVE
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.


METHODS
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.
Department of General Psychiatry, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
Tom
T
Burns
Ian
I
White
Sarah
S
Byford
Matthew
M
Fiander
Francis
F
Creed
Tom
T
Fahy
D000367:Age Factors; D019090:Case Management; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D011329:Prisoners; D012044:Regression Analysis; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome