Economic implications of shared care arrangements. A primary care based study of patients in an inner city sample.
BACKGROUND
Providing care for people with serious and enduring mental health problems has been prioritised in a number of countries. It has been recognised that good liaison between primary and secondary care services is required for care to be effective. However, little is known about the resource implications of different levels of 'shared care'. The aim of this study is to compare service use and costs of different levels of shared care between primary and secondary care services.


METHODS
Service use data were collected at baseline and one year later for participants with severe mental illness and costs were calculated. Levels of shared care were categorised into low, medium and high tertiles. Comparisons were made between the groups using multivariate analysis to control for participant characteristics.


RESULTS
Participants receiving a low level of shared care used residential care less and were less likely to have contacts with a psychiatrist or social worker than those receiving medium or high levels of shared care. Mean costs for a low level of shared care were significantly lower than for a medium level (a difference of pound 2606, 90% CI pound 452 to pound 4923), but not significantly lower than for a high level of shared care (difference of pound 1867, 90% CI- pound 287 to pound 3903).


CONCLUSIONS
Different levels of shared care are associated with different patterns of service use, with greater resource consumption associated with a medium level of shared care. Further work is required to investigate the causal links between integrated care and service use and costs.
McCrone
P
P
Centre for the Economics of Mental Health, Health Services Research Dept., Institute of Psychiatry, London, UK. p.mccrone@iop.kcl.ac.uk
Fitzpatrick
N K
NK
Mathieson
E
E
Chisholm
D
D
Nourmand
S
S
D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D008605:Mental Health Services / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D011569:Psychiatric Status Rating Scales; D011570:Psychiatry / Q000191:economics; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom; D019037:Urban Health Services / Q000191:economics*; D000078329:Workforce