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A Controlled Trial of Home-Based Acute Psychiatric Services

II: Treatment Patterns and Costs

Published online by Cambridge University Press:  02 January 2018

Tom Burns ,
James Raftery ,
Alan Beadsmoore ,
Sean McGuigan  and
Mark Dickson
Tom Burns*
Affiliation:
Department of Mental Health Sciences
James Raftery
Affiliation:
Department of Public Health Sciences
Alan Beadsmoore
Affiliation:
Department of Mental Health Sciences, St George's Hospital Medical School, London
Sean McGuigan*
Affiliation:
Department of Mental Health Sciences, St George's Hospital Medical School, London
Mark Dickson
Affiliation:
Department of Mental Health Sciences, St George's Hospital Medical School, London
*
∗Department of Mental Health Sciences, St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE
∗Department of Mental Health Sciences, St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE
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Abstract

Treatment records of 94 patients treated in an experimental home-based psychiatric service and 78 control patients in standard care were collected over one year. There was a substantial reduction in in-patient care in the experimental group, both in terms of proportion admitted and duration of admissions, despite similar out-patient and general practice care. The total treatment costs were significantly larger (>50%) for standard care when controlled for by diagnostic grouping. Costs were further examined by including all specialist psychiatric care, and by excluding patients with primary diagnoses of brain damage or alcoholism. Sensitivity analysis explored the effects of increasing the cost of home visits. The relative cost effectiveness of the experimental service persisted. Clinical and social outcome was similar in control and experimental groups.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 163 , Issue 1 , July 1993 , pp. 55 - 61
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Bennett, D. H. (1991) The international perspective. In Community Psychiatry (eds Bennett, D. H. & Freeman, H. L.), pp. 626–649. London: Churchill Livingstone.Google Scholar
Braun, P., Kochansky, G., Shapiro, R., et al (1981) Overview: deinstitutionalisation of psychiatric patients, a critical review of outcome studies. American Journal of Psychiatry, 138, 736–737.Google Scholar
Creed, F., Black, D., Anthony, P., et al (1990) Randomised controlled trial of day patient versus inpatient psychiatric treatment. British Medical Journal, 300, 1033–1037.CrossRefGoogle ScholarPubMed
Croft-Jeffreys, C. & Wilkinson, G. (1989) Estimated costs of neurotic disorder in UK general practice. Psychological Medicine, 19, 549–558.CrossRefGoogle ScholarPubMed
Davis, A. E., Dinitz, S. & Pasamanick, M. O. (1972) The prevention of hospitalisation in schizophrenics: five years after an experimental programme. American Journal of Orthopsychiatry, 3, 375–388.CrossRefGoogle Scholar
Dean, C. & Gadd, E. M. (1990) Home treatment for acute psychiatric illness. British Medical Journal, 301, 1021–1023.CrossRefGoogle ScholarPubMed
Drummond, M. F., Stoddard, G. L. & Torrance, G. W. (1987) Methods for the Economic Evaluation of Health Care Programmes. Oxford: Oxford University Press.Google Scholar
Fenton, S. R., Tessier, L. & Struenino, E. L. (1979) A comparative trial of home and hospital psychiatric care: one year follow up. Archives of General Psychiatry, 36, 1073–1079.CrossRefGoogle ScholarPubMed
Goldberg, D. P. & Huxley, P. (1980) Mental Illness in the Community. London: Tavistock.Google Scholar
Hoult, J. (1983) Psychiatric Hospital versus Community Treatment - A Controlled Study. Sydney: Department of Health, New South Wales.Google Scholar
Hoult, J., Reynolds, I., Powis, M. C., et al (1983) Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Orthopsychiatry, 17, 160–167.CrossRefGoogle ScholarPubMed
Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal, 286, 1705–1709.CrossRefGoogle ScholarPubMed
Jones, D. (1987) Community psychiatry in the borders. In Creating Community Mental Health Services in Scotland (ed. Drucker, N.). Edinburgh: SAMH Publications.Google Scholar
Knapp, M. & Beecham, J. (1990) Costing mental health services. Psychological Medicine, 20, 893–908.CrossRefGoogle ScholarPubMed
Langsley, D. G., Flomenhaft, K. & Machotka, P. (1969) Follow-up evaluations of family crisis therapy. American Journal of Orthopsychiatry, 39, 753–759.CrossRefGoogle ScholarPubMed
Morgan, H. G. (1992) Suicide prevention. Hazards on the fast lane to community care. British Journal of Psychiatry, 160, 149–153.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, I. M., Connolly, J., et al (1992a) The Daily Living Programme: preliminary comparison of community versus hospital-based treatment for the seriously mentally ill facing emergency admission. British Journal of Psychiatry, 160, 379–384.CrossRefGoogle ScholarPubMed
Muijen, M., Marks, I. M., Connolly, J., et al (1992) Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial. British Medical Journal, 304, 749–754.CrossRefGoogle ScholarPubMed
Overall, J. E. & Gorham, D. L. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
Paykel, E. S. (1985) The Clinical Interview for Depression. Journal of Affective Disorders, 9, 85–96.CrossRefGoogle ScholarPubMed
Paykel, E. S., Mangen, S. P., Griffith, J. H., et al (1982) Community psychiatric nursing for neurotic patients - a controlled trial. British Journal of Psychiatry, 140, 573–581.CrossRefGoogle ScholarPubMed
Paykel, E. S., & Griffiths, J. (1983) Satisfaction with treatment. In Community Psychiatric Nursing for Neurotic Patients (eds Paykel, E. S. & Griffiths, J.), pp. 46–53. London: Royal College of Nursing.Google Scholar
Pocock, S. J. (1983) Basic principles of statistical analysis. In Clinical Trials. A Practical Approach, pp. 187–233. Chichester: Wiley.Google Scholar
Raftery, J. (1991) Social policy and community psychiatry in the UK. In Community Psychiatry (eds Bennett, D. H. & Freeman, H. L.), pp. 595–625. London: Churchill Livingstone.Google Scholar
Remington, M. & Tyrer, P. J. (1979) The Social Functioning Schedule - a brief semi-structured interview. Social Psychiatry, 14, 151–157.CrossRefGoogle Scholar
Shepherd, M., Cooper, B., Brown, A., et al (1981) Psychiatric Illness in General Practice (2nd edn). Oxford: Oxford University Press.Google Scholar
Stefansson, C. G. & Cullberg, J. (1986) Introducing community mental health services. Acta Psychiatrica Scandinavica, 74, 368–378.CrossRefGoogle ScholarPubMed
Stein, L. I. & Test, M. A. (1980) Alternative to mental hospital treatment. I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.CrossRefGoogle ScholarPubMed
Tantam, D. (1985) Alternatives to hospitalisation. British Journal of Psychiatry, 146, 1–4.CrossRefGoogle ScholarPubMed
Weich, S. R. (1992) The cost benefit analysis of the Daily Living Programme Getter). British Journal of Psychiatry, 161, 715–716.CrossRefGoogle Scholar
Weisbrod, B. A., Test, M. A. & Stein, L. I. (1980) Alternative to mental hospital. II: Economic cost benefit analysis. Archives of General Psychiatry, 37, 400–405.CrossRefGoogle Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) The Measurement and Classification of Psychiatric Symptoms. London: Cambridge University Press.Google Scholar
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