Skip to main content Accessibility help
×
Home

Contents:

Information:

  • Access

Actions:

      • Send article to Kindle

        To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

        Comments on the UK700 case management trial
        Available formats
        ×

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

        Comments on the UK700 case management trial
        Available formats
        ×

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Comments on the UK700 case management trial
        Available formats
        ×
Export citation

The UK700 Group (2000) presents a comparative cost analysis of intensive case management (ICM) v. standard case management for patients with severe mental illness. It failed to find any significant difference in duration of in-patient treatment between the two groups at 2 years, and the cost of care was thus roughly equal. The authors conclude that “the policy of advocating intensive case management for all patients with severe psychosis is not supported….”.

While the execution of the UK700 study is admirable in terms of its sheer number of subjects, the design is critically restricted by the very nature of the ‘intensive case management’ offered. Indeed, the mean number of contacts per client was 100 (s.d.=64) v. 64 (s.d.=30) in the control group; this equates to around one visit per week and one per fortnight, respectively. Comparison with our local (ICM) service shows that our case managers visit clients far more regularly than this (daily, if necessary). While this might seem excessive, it appears that it is crucial to maintaining such patients in the community, and is ultimately cost-effective. Indeed, Preston & Fazio (Reference Preston and Fazio2000) showed that for our ICM service, with a capped case-load per case worker of around 10 patients, and a mean number of annual community contacts of 164 (s.d.=20) v. 56 (s.d.=100) for non-intensive patients, in-patient bed-days fell dramatically (from a mean of 118 days (s.d.=113) per year before ICM, to 57 days (s.d.=91) in the second year of the ICM intervention). The control group showed no such reduction in bed-days, and the overall cost saving (factoring in the increased out-patient costs for the ICM group) at the end of the 2 years was AU$801 475 for 65 patients (P <0.001).

Thus, it is important that the precise nature of the intervention is examined before dismissing ICM as a cost-effective model of service delivery.

Preston, N. J. & Fazio, S. (2000) Establishing the efficacy and cost effectiveness of community intensive case management of long-term mentally ill: a matched control group study. Australian and New Zealand Journal of Psychiatry, 34, 114121.
UK700 Group (2000) Cost-effectiveness of intensive v. standard case management for severe psychotic illness. UK700 case management trial. British Journal of Psychiatry, 176, 537543.