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Do care patterns change over time in a newly established mental health service? A report from the UK700 trial

Published online by Cambridge University Press:  16 April 2020

M. Fiander ,
T. Burns ,
O.C. Ukoumunne ,
T. Fahy ,
F. Creed ,
P. Tyrer  and
S. Byford
M. Fiander
Affiliation:
Department of Mental Health, St. George’s Hospital Medical School, London, UK
T. Burns*
Affiliation:
Department of Psychiatry, Warneford Hospital, University of Oxford, OxfordOX3 7JX, UK
O.C. Ukoumunne
Affiliation:
Murdoch Children’s Research Institute, Parkville, Vic., Australia
T. Fahy
Affiliation:
Institute of Psychiatry, Kings College, London, UK
F. Creed
Affiliation:
School of Psychiatry and Behavioural Sciences, Manchester Royal Infirmary, Manchester, UK
P. Tyrer
Affiliation:
Department of Public Mental Health, Imperial College School of Medicine, London, UK
S. Byford
Affiliation:
Centre for the Economics of Mental Health, Institute of Psychiatry, London, UK
*
*Corresponding author. Tel.: +44 1865 22 6474. E-mail address: tom.burns@psych.ox.ac.uk (T. Burns).
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Abstract

Purpose.

Data on the process of mental health care is scant. Most studies focus on services at their inception when activity may be atypical and then usually present data only mean values for the reported variables over the whole study period. We aimed to test whether care delivery changes over time, and to describe any changes at the individual patient and team levels.

Methods.

Process data on 272 patients in three new intensive case management (ICM) teams were collected over 2 years. Interventions were prospectively recorded using clinician-derived categories. Changes over time are described at both patient and team level.

Results.

The number of contacts and the proportion of face-to-face activity were remarkably constant after the first month at the patient level. The proportion of ‘psychiatric’ interventions (main focus on medication or a specific ‘mental health’ intervention performed) increased greatly after the first 6 months. The care activity received by individual patients varied considerably. Overall, teams varied significantly in the extent to which their activity rates were sustained over time.

Conclusions.

New ICM teams deliver highly individualised care with more marked differences in treatment patterns between patients in the same team than mean differences between teams. The early ‘engagement’ period is marked by a greater focus on social care. There is evidence of differences in sustainability of the services by site.

Keywords

PsychosisCase managementLongitudinalCare patterns
Type
Original articles
Information
European Psychiatry , Volume 21 , Issue 5 , July 2006 , pp. 300 - 306
Copyright
Copyright © Elsevier SAS 2006

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