BACKGROUND: It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial. AIMS: To investigate outcome generation in the UK700 trial. METHOD: 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.
BACKGROUND: It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial. AIMS: To investigate outcome generation in the UK700 trial. METHOD: 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.
Authors: Chris Metcalfe; Ian R White; Tim Weaver; Obioha C Ukoumunne; Kate Harvey; Theresa Tattan; Simon G Thompson Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2005-09-15 Impact factor: 4.328
Authors: Helen Killaspy; Sonia Johnson; Barbara Pierce; Paul Bebbington; Stephen Pilling; Fiona Nolan; Michael King Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2008-11-27 Impact factor: 4.328
Authors: Sasha Shepperd; Simon Lewin; Sharon Straus; Mike Clarke; Martin P Eccles; Ray Fitzpatrick; Geoff Wong; Aziz Sheikh Journal: PLoS Med Date: 2009-08-11 Impact factor: 11.069
Authors: Jolanda Stobbe; André I Wierdsma; Rob M Kok; Hans Kroon; Bert-Jan Roosenschoon; Marja Depla; Cornelis L Mulder Journal: BMC Psychiatry Date: 2014-02-15 Impact factor: 3.630