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Effects of case-load size on the process of care of patients with severe psychotic illness

Report from the UK700 trial

Department of General Psychiatry, St George's Hospital Medical School, London

OBIOHA C. UKOUMUNNE, BSc

Department of Medical Statistics and Evaluation, Imperial College School of Medicine, Hammersmith Hospital, London

SARAH BYFORD, MSc

Centre for Health Economics, University of York, York

TOM FAHY, MRCPsych

The Maudsley Hospital, London

KAY RAJ KUMAR, MSc

St Charles Hospital, London

Correspondence: Professor Tom Burns, Department of General Psychiatry, St George's Hospital Medical School, Jenner Wing, Cranmer Terrace, London SW17 0RE

Declaration of interest None.

See editorial, pp. 386-387, this issue.

Background Studies of intensive case management (ICM) for patients with psychotic illnesses have produced conflicting results in terms of outcome. Negative results have sometimes been attributed to a failure to deliver differing patterns of care.

Aims To test whether the actual care delivered in a randomised clinical trial of ICM v. standard case management (the UK700 trial) differed significantly.

Method Data on 545 patients' care were collected over 2 years. All patient contacts and all other patient-centred interventions (e.g. telephone calls, carer contacts) of over 15 minutes were prospectively recorded. Rates and distributions of these interventions were compared.

Results Contact frequency was more than doubled in the ICM group. There were proportionately more failed contacts and carer contacts but there was no difference in the average length of individual contacts or the proportion of contacts in the patients' homes.

Conclusions The failure to demonstrate outcome differences in the UK700 study is not due to a failure to vary the treatment process. UK standard care contains many of the characteristics of assertive outreach services and differences in outcome may require that greater attention be paid to delivering evidence-based interventions.

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