Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial.
BACKGROUND
It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial.


OBJECTIVE
To investigate outcome generation in the UK700 trial.


METHODS
A qualitative investigation was undertaken in one UK700 centre.


RESULTS
Both intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and in-patient discharge. However, ICM was advantaged in managing some non-compliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients.


CONCLUSIONS
The impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions.
Department of Social Science and Medicine, Imperial College, London, UK. t.weaver@ic.ac.uk
Tim
T
Weaver
Peter
P
Tyrer
Jane
J
Ritchie
Adrian
A
Renton
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D019090:Case Management / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004637:Emergency Services, Psychiatric; D006760:Hospitalization; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D010349:Patient Compliance / Q000523:psychology; D011618:Psychotic Disorders / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D006113:United Kingdom