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The British Journal of Psychiatry (2002) 181: 236-241
© 2002 The Royal College of Psychiatrists

Exposure to case management: relationships to patient characteristics and outcome

Report from the UK700 trial

TOM BURNS, MD, FRCPsych

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

IAN WHITE, MSc

MRC Biostatistics Unit, Institute of Public Health, Cambridge

SARAH BYFORD, MSc

Centre for the Economics of Mental Health, Institute of Psychiatry, London

MATTHEW FIANDER, MSc

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

FRANCIS CREED, FMedSci

School of Psychiatry and Behavioural Sciences, Manchester Royal Infirmary

TOM FAHY, MD

Institute of Psychiatry, King's College, London, UK

Correspondence: Professor Tom Burns, Department of General Psychiatry, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Tel: 020 8725 5547; fax: 020 8725 3538

Declaration of interest None.

Background Trials in community psychiatry must balance rigour with generalisability. The UK700 trial failed to find a significant effect on hospitalisation, but its sample population contained significant heterogeneity of exposure to case management in the two groups.

Aims To test whether patients successfully exposed to a minimum of 12 months' intensive case management over the 2-year follow-up period achieved reduced hospitalisation.

Method Of 679 participants with hospitalisation data, 84 were identified as having < 12 months' exposure owing to prolonged hospitalisation, imprisonment or a combination of the two. These patients were excluded and outcomes tested for the remaining 595 patients.

Results Overall reduced case-load size did not reduce hospitalisation or treatment costs over 2 years despite elimination of outliers. Age, previous hospitalisation and source of recruitment to the study all correlated with outcome.

Conclusions Case-load reduction is not in itself enough to reduce the need for hospital care in psychosis. Baseline patient characteristics (in particular length of previous hospitalisation and recruitment from in-patient care) have a significant influence and should be allowed for in power calculations. Identifying the optimal clinical profile for patients likely to benefit from intensive case management remains a pressing need for further studies.


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