Psychiatric case management in a tertiary psychiatric hospital

ABSTRACT

Objective: Psychiatric case management was introduced in inpatient general psychiatry wards in a tertiary psychiatric hospital in late 2003. A brokerage model of case management is used espousing advocacy with case managers acting in their patient’s best interest to encourage and facilitate use of appropriate psychiatric care and reduce fragmentation and costs. Data on patients’ case managed in 2004 and 2005 was analysed to determine the effectiveness of the service in terms of clinical outcomes and service linkages provided. Methods: Psychiatric case managers maintained databases on the patients referred to them. There were 231 patients in 2004 and 375 patients in 2005. Analyses were performed by using SPSS 13.0 with statistical significance set at P <0.05. Descriptive statistics was used and differences between the 2 cohorts in outcome measures were assessed using Chi-square or Fisher’s Exact test. Results: The service developed with a 62.3% increase in the number of cases accepted for case management in the second year. There was improvement in clinical outcomes, such as reductions in unplanned re-admissions within 28 days from 4.8% in the first year to 2.1% in the second year. A reduction in suicide attempts and forensic complications was also found. There were significant reductions in re-hospitalisation in 2004, from 28.1% to just 6.9% after case management was provided (p<0.001). Conclusion: The brokerage model of case management used in this setting was effective in reducing re-hospitalisation, unplanned readmissions, suicide attempts and forensic complications for psychiatric patients