A randomised controlled study of close monitoring of vulnerable psychiatric patients
The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400...
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| Veröffentlicht in: | The Lancet (British edition) 1995-03, Vol.345 (8952), p.756-759 |
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| creator | Tyrer, P. Morgan, J. Van Horn, E. Jayakody, M. Evans, K. Brummell, R. White, T. Baldwin, D. Harrison-Read, P. Johnson, T. |
| description | The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32·5%) were lost to follow-up compared with 40 (20·4%) of 196 patients receiving close supervision (p= |
| doi_str_mv | 10.1016/S0140-6736(95)90640-1 |
| format | Article |
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2=7·61, p<0·01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(95)90640-1</identifier><identifier>PMID: 7891486</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Care ; Community Mental Health Services ; Community treatment. Ambulatory treatment. Home care ; Female ; Health care ; Hospitals ; Humans ; Inner London ; London ; Male ; Medical research ; Medical sciences ; Mental health ; Middle Aged ; Patient Admission ; Patient Dropouts ; Patients ; Psychiatric Department, Hospital ; Psychiatric disorders ; Psychiatry ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychotic Disorders - therapy ; Randomized controlled trials ; Registries ; Schizophrenia - therapy ; Social services ; Treatments</subject><ispartof>The Lancet (British edition), 1995-03, Vol.345 (8952), p.756-759</ispartof><rights>1995</rights><rights>1995 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Mar 25, 1995</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-d603d3367af4ae6671c91b31c1da903bb317c6327efa62f05791b7133dcb94ae3</citedby><cites>FETCH-LOGICAL-c508t-d603d3367af4ae6671c91b31c1da903bb317c6327efa62f05791b7133dcb94ae3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/198987031?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,30979,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3464561$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/7891486$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tyrer, P.</creatorcontrib><creatorcontrib>Morgan, J.</creatorcontrib><creatorcontrib>Van Horn, E.</creatorcontrib><creatorcontrib>Jayakody, M.</creatorcontrib><creatorcontrib>Evans, K.</creatorcontrib><creatorcontrib>Brummell, R.</creatorcontrib><creatorcontrib>White, T.</creatorcontrib><creatorcontrib>Baldwin, D.</creatorcontrib><creatorcontrib>Harrison-Read, P.</creatorcontrib><creatorcontrib>Johnson, T.</creatorcontrib><title>A randomised controlled study of close monitoring of vulnerable psychiatric patients</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32·5%) were lost to follow-up compared with 40 (20·4%) of 196 patients receiving close supervision (p=<0·005). However, patients under close supervision had significantly more admissions (30% vs 18%, χ
2=7·61, p<0·01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Care</subject><subject>Community Mental Health Services</subject><subject>Community treatment. Ambulatory treatment. Home care</subject><subject>Female</subject><subject>Health care</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inner London</subject><subject>London</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Mental health</subject><subject>Middle Aged</subject><subject>Patient Admission</subject><subject>Patient Dropouts</subject><subject>Patients</subject><subject>Psychiatric Department, Hospital</subject><subject>Psychiatric disorders</subject><subject>Psychiatry</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. 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Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tyrer, P.</au><au>Morgan, J.</au><au>Van Horn, E.</au><au>Jayakody, M.</au><au>Evans, K.</au><au>Brummell, R.</au><au>White, T.</au><au>Baldwin, D.</au><au>Harrison-Read, P.</au><au>Johnson, T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomised controlled study of close monitoring of vulnerable psychiatric patients</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1995-03-25</date><risdate>1995</risdate><volume>345</volume><issue>8952</issue><spage>756</spage><epage>759</epage><pages>756-759</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>The care programme approach was introduced in mental health services in the UK in 1991. It was intended to improve the quality of care and prevent patients losing contact with care services and, by implication, to reduce psychiatric admissions. We did a study to find out if the approach worked. 400 patients from a London inner-city area who had been identified as psychiatrically vulnerable and included on a case register of patients with special needs were randomised into two groups of 200 each. One group received close supervision by nominated key-workers (as recommended in the care programme approach of the UK Department of Health), and the other received standard follow-up from psychiatric and social services. Outcome was recorded after eighteen months. Data on 393 patients was available for analysis. Of 197 patients allocated to standard care, 64 (32·5%) were lost to follow-up compared with 40 (20·4%) of 196 patients receiving close supervision (p=<0·005). However, patients under close supervision had significantly more admissions (30% vs 18%, χ
2=7·61, p<0·01) and spent 68% more days in hospital than the standard group. The findings of greater hospital-bed use, which differ from those of studies with community-based psychiatric teams, suggest that close supervision by a single key worker, as recommended in the care programme approach, will lead to greater success in maintaining contact with vulnerable patients, but is likely to lead to more psychiatric admissions.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>7891486</pmid><doi>10.1016/S0140-6736(95)90640-1</doi><tpages>4</tpages></addata></record> |
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| subjects | Adult Aged Biological and medical sciences Care Community Mental Health Services Community treatment. Ambulatory treatment. Home care Female Health care Hospitals Humans Inner London London Male Medical research Medical sciences Mental health Middle Aged Patient Admission Patient Dropouts Patients Psychiatric Department, Hospital Psychiatric disorders Psychiatry Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychotic Disorders - therapy Randomized controlled trials Registries Schizophrenia - therapy Social services Treatments |
| title | A randomised controlled study of close monitoring of vulnerable psychiatric patients |
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