© 2003 The Royal College of Psychiatrists
Assessing the value of assertive outreach
Qualitative study of process and outcome generation in the UK700 trial
Department of Social Science and Medicine, Imperial College
Department of Psychological Medicine, Imperial College
National Centre for Social Research (formerly SCPR), London, UK
Department of Social Science and Medicine, Imperial College, London
Correspondence: Tim Weaver, Department of Social Science and Medicine, Imperial College of Science, Technology and Medicine, Charing Cross Campus, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK. Tel: 020 7594 0863; fax: 020 7594 0866; e-mail: t.weaver{at}ic.ac.uk
Declaration of interest None. Funding detailed in Acknowledgements.
* This paper was accepted before P.T. became Editor of the Journal.
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.
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