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Case management for schizophrenic patients at risk for rehospitalization: A case control study

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Abstract

In many countries deinstitutionalization of psychiatric patients is accompanied by fragmentation of care, giving responsibility to an array of different services and providers. One of the possible side effects of this is an increased rehospitalization rate and length of stay. The need to coordinate the services involved for the benefit of individuals has led to the conceptual development of case management. However, despite an apparent belief in the effectiveness of case management, there is only limited scientific evidence to support this assumption. In the case control study presented we compared a group of 97 schizophrenic patients in the aftercare of case management services with a group of patients who received no outpatient care by case management services after discharge from hospital. Each patient in the case-managed group was exactly matched with a control patient with regard to diagnosis and known risk factors for rehospitalization. Additionally, we considered influencing factors that result from general health system conditions such as regional differences and different types of hospital care. Our analyses demonstrate that, during an observation period of 2.5 years, case management had neither a significant effect on the risk of rehospitalization nor on the length of time in hospital in the event of rehospitalization.

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References

  • Audit Commission (1986) Making a reality of community care. HMSO, London

    Google Scholar 

  • Bachrach L (1987) The chronic psychiatric patient as a “difficult” patient: a conceptual analysis. In: Meyerson AT (ed) Barriers to treating the chronic mentally ill. New Directions in mental health services. Jossey-Bass, San Francisco, pp 35–50

    Google Scholar 

  • Bachrach L (1989) Case management: toward a shared definition. Hosp Community Psychiatry 40:883–884

    PubMed  Google Scholar 

  • Bachrach L (1992) Case management revisited. Hosp Community Psychiatry 43(3):209–210

    PubMed  Google Scholar 

  • Beeson PG (1983) The bureaucratic context of mental halth care. In: Littrel WB (ed) Bureaucracy as a social problem. JAI Press, Greenwich, CT

    Google Scholar 

  • Biehl H, Maurer K, Schubart C, Krumm B, Jung E (1986) Prediction of outcome and utilization of medical services in a prospective study of first onset schizophrenics. Eur Arch Psychiatry Neurol Sci 236:139–147

    Article  PubMed  Google Scholar 

  • BMJFFG (1988) Empfehlungen der Expertenkomission der Bundesregierung zur Reform der Versorgung im psychiatrischen und psychotherapeutisch-psychosomatischen Bereich auf der Grundlage des Modellprogramms Psychiatrie. Bonn

  • Bond G, Miller L, Krumwied R, Ward R (1988) Assertive case management in three CMHCs: a controlled study. Hosp Community Psychiatry 39:411–418

    PubMed  Google Scholar 

  • Breaky WR, Kaminsky MJ (1982) An assessment of Jarvis' law in an urban catchment area. Hosp Community Psychiatry 33: 661–664

    PubMed  Google Scholar 

  • Carpenter WT Jr, Strauss JS (1991) The prediction of outcome in schizophrenia IV: eleven-year follow-up of the Washington IPSS cohort. J Nerv Ment Dis 179:517–525

    PubMed  Google Scholar 

  • Clifford P, Craig T (1988) Case management systems for the long-term mentally ill. A proposed interagency initiative. NUPRD, London

    Google Scholar 

  • Deutscher Bundestag (1975) Bericht über die Lage der Psychiatrie in der Bundesrepublik Deutschland — zur psychiatrischen und psychotherapeutischen/psychosomatischen Versorgung der Bevölkerung. Drucksache 7/4200. Bonn

  • Fabrega H, Ahn C, Mezzich J (1991) Can multitaxial diagnosis predict future use of psychiatric hospitalization? Hosp Community Psychiatry 42(9):920–924

    PubMed  Google Scholar 

  • Fisher G, Landis D, Clark K (1988) Case management service provision and client change. Community Ment Health J 24:134–142

    Article  PubMed  Google Scholar 

  • Franklin J, Solowitz B, Mason M, Clemons JR, Miller GE (1987) An evaluation of case management. Am J Public Health 77: 674–678

    PubMed  Google Scholar 

  • Freeman HL, Fryers TH, Henderson JH (1985) Mental health services in Europe: 10 years on. World Health Organization, Regional Office of Europe: Copenhagen

    Google Scholar 

  • Harris M, Bergman HC (1988) Clinical case management for the chronically mentally ill: a conceptual analysis. In: Harris M, Bachrach L (eds) New Directions in mental health services. Jossey-Bass; San Francisco, pp 5–13

    Google Scholar 

  • Henisz J (1966) A follow-up study of schizophrenic patients. Compr Psychiatry 7:524–529

    PubMed  Google Scholar 

  • Her Majesty's Stationery Office (1989). Caring for people. HMSO, London

    Google Scholar 

  • Holloway F (1991) Case management for the mentally ill: looking at the evidence. Int J Soc Psychiatry 37(1):2–13

    PubMed  Google Scholar 

  • Johansen KH (1983) The impact of patients with chronic character pathology on a hospital inpatient unit. Hosp Community Psychiatry 34:842–846

    PubMed  Google Scholar 

  • Jonsson H, Nyman AK (1984) Prediction of outcome in schizophrenia. Acta Psychiatr Scand 69:274–291

    PubMed  Google Scholar 

  • Kanter J (1989) Clinical case management. Hosp Community Psychiatry 40:361–368

    PubMed  Google Scholar 

  • Lamb HR (1980) Therapist-case managers: more than brokers of services. Hosp Community Psychiatry 31:762–764

    PubMed  Google Scholar 

  • Renshaw J (1987) Care planning and case management. Br J Soc Work 18:79–105

    Google Scholar 

  • Renshaw J (1988) Care in the community: individual care planning and case management. Br J Soc Work 18 (Suppl):79–105

    Google Scholar 

  • Riecher A, Rössler W, Löffler W, Fätkenheuer B (1991) Factors influencing compulsory admission of psychiatric patients. Psychol Med 21:197–208

    PubMed  Google Scholar 

  • Rössler W (1992) Sozialpsychiatrische Dienste in der Bundesrepublik Deutschland — Ein Überblick. Gesundheitswesen 54: 19–24

    PubMed  Google Scholar 

  • Rössler W, Häfner H, Martini H, Heiden W an der, Jung E, Löffler W (1987) Landesprogramm zur Weiterentwicklung der außerstationären psychiatrischen Versorgung Baden-Württemberg —Analysen, Konzepte, Erfahrungen. Deutscher Studienverlag: Weinheim

    Google Scholar 

  • Rössler W, Riecher A, Löffler W, Fätkenheuer B (1991) Community care in child psychiatry. An empirical approach using the concept of travel time. Soc Psychiatry Psychiatr Epidemiol 26, 28–33

    Article  PubMed  Google Scholar 

  • Rössler W, Fätkenheuer B, Löffler W, Riecher-Rössler A (1992) Does case management reduce the rehospitalization rate? Acta Psychiatr Scand 86:445–449

    PubMed  Google Scholar 

  • Rubin A (1992) Is case management effective for people with serious mental illness? A research review. Health Soc Work 17(2):138–150

    PubMed  Google Scholar 

  • Solomon P (1992) The efficacy of case management services for severely mentally disabled clients. Community Ment Health J 28(3):163–180

    Article  PubMed  Google Scholar 

  • Statistisches Landesamt Baden-Württemberg (1985a) Statistische Berichte. Voraussichtliche Entwicklung der Bevölkerung auf der Basis vom 1.1.1984. Stuttgart

  • Statistisches Landesamt Baden-Württemberg (1985b). Gemeindestatistik 1985. Amtliches Gemeindeverzeichnis Baden-Württemberg 1985. Stuttgart.

  • Steinwachs DM, Cullum HM, Dorwart RA, Flynn L, Frank R, Friedman MB, Herz MI, Mulvey EP, Snowden L, Test MA, Tremaine L (1992) Service systems research. Schizophr Bull 18(4):627–668

    PubMed  Google Scholar 

  • Stephens JH, Astrup C, Mangrum JC (1966) Prognostic factors in recovered and deteriorated schizophrenics. Am J Psychiatry 122:1116–1121

    PubMed  Google Scholar 

  • Thornicroft G (1990) Case managers for the mentally ill. Soc Psychiatry Psychiatr Epidemiol 25:141–142

    Article  PubMed  Google Scholar 

  • Vaillant G (1964) Prospective prediction of schizophrenic remission. Arch Gen Psychiatry 11:509–518

    PubMed  Google Scholar 

  • Vaslamatzis GR, Kontaxakis V, Markidis M, Katsouyanni K (1987) Social and resource factors related to the utilization of emergency psychiatric services in the Athens area. Acta Psychiatr Scand 75:95–98

    PubMed  Google Scholar 

  • Weiss P, Macaulay JR, Pincus A (1967) Geographic location and state hospital utilization. Am J Psychiatry 124:637–641

    PubMed  Google Scholar 

  • Weyerer S, Dilling H (1978) Zur Bedeutung der geographischen Lage psychiatrischer Krankenhäuser für Aufnahmeraten und Aufenthaltsdauer. Psychiatr Praxis 5:58–64

    Google Scholar 

  • Wing J (1991) Vision and reality: In. Hall P, Brockington I (eds) The closure of mental hospitals. Gaskell, London, pp 10–19

    Google Scholar 

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Rössler, W., Löffler, W., Fätkenheuer, B. et al. Case management for schizophrenic patients at risk for rehospitalization: A case control study. Eur Arch Psychiatry Clin Nuerosci 246, 29–36 (1995). https://doi.org/10.1007/BF02191812

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  • DOI: https://doi.org/10.1007/BF02191812

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