Monday, August 20, 2007

Mixed results for assertive outreach

Intensive case management - or assertive outreach - aims to ensure that people with severe mental illness spend the minimum amount of time possible in hospital. Each person with severe mental illness and at high risk of readmission is allocated a nurse, social worker or other clinician (a case manager) who is usually responsible for between 10 and 20 patients. The case manager takes primary responsibility for keeping contact with the patient, assessing their needs and ensuring that their needs are met. There is usually a team of people responsible for delivering care which meets daily, includes nurses, social workers, psychologists and doctors and which is available 24 hours a day. However, a number of trials over the last 35 years have failed to show that assertive outreach reduces the use of hospital care. Some showed a large reduction, others found no effect while some actually showed an increase in hospital care. A review of studies into assertive outreach has found that when hospital use is high intensive case management can reduce it but it is less successful when hospital use is already low so that the benefits of assertive outreach could be marginal in places that have already achieved a low rate of bed use. The review also found that team organisation was more important than the details of staffing and that it might not be necessary to apply the full model of assertive community treatment to achieve reductions in inpatient care.

Burns, Tom ... [et al] - Use of intensive case management to reduce time in hospital in people with severe mental illness : systematic review and meta-regression British Medical Journal August 18, 2007, 336-340

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