Document Detail

Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough.
MedLine Citation:
PMID:  11989986     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heavy users of psychiatric services, often defined as the population that uses the most beds, consume a large part of the resources used by the whole service, despite being relatively small in number. Any intervention that reduces heavy use is therefore likely to lead to significant savings, and enhancement of standard care using a form of intensive case management akin to assertive community treatment was thought to be a pragmatic strategy for testing in this group. METHODS: The effectiveness of enhanced community management (ECM) was compared with standard care alone in heavy users, who represented the 10% of patients with the highest number of hospital admissions and occupied bed days over the previous 6.5 years in an outer London borough. One hundred and ninety-three patients were randomly assigned to ECM or standard care and their use of services was determined after 1 and 2 years, with assessments of costs, clinical symptoms, needs, and social function made before entry into the study and after 1 and 2 years. RESULTS: Despite a 24 fold increase in community contacts in the study group, there were no significant differences between the two groups in any of the main outcome measures. Small savings on in-patient and day-hospital service costs were counterbalanced by the increased costs of outpatient and community care for the subjects assigned to ECM. Clinical outcome data derived from interviews in two-thirds of the subjects were similar in both groups. CONCLUSIONS: Providing additional intensive community focused care to a group of heavy users of psychiatric in-patient services in an outer London borough does not lead to any important clinical gains or reduced costs of psychiatric care.
P Harrison-Read; B Lucas; P Tyrer; J Ray; K Shipley; S Simmonds; M Knapp; A Lowin; A Patel; M Hickman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Psychological medicine     Volume:  32     ISSN:  0033-2917     ISO Abbreviation:  Psychol Med     Publication Date:  2002 Apr 
Date Detail:
Created Date:  2002-05-06     Completed Date:  2002-10-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1254142     Medline TA:  Psychol Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  403-16     Citation Subset:  IM    
Park Royal Centre for Mental Health, Department of Public Mental Health, Imperial College School of Medicine and Centre for the Economics of Mental Health, London.
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MeSH Terms
Case Management / economics*
Community Mental Health Services / economics*
Cost Control
Hospital Bed Capacity / economics
Length of Stay / economics*
Middle Aged
National Health Programs / economics
Outcome and Process Assessment (Health Care)
Patient Care Team / economics
Patient Readmission / economics*
Psychotic Disorders / economics*,  therapy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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