Effects of case-load size on the process of care of patients with severe psychotic illness - Report from the UK700 trial

Background Studies of intensive case management (ICM) for patients with psy chotic illnesses have produced conflicting results in terms of outcome. Neg ative results have sometimes been attributed to a failure to deliver differ ing patterns of care. Aims To test whether the actual care delivered in a randomised clinical tri al of ICM v. standard case management (the UK700 trial) differed significan tly. Method Data on 545 patients' care were collected over 2 years. All patient contacts and all other patient-centred interventions (e.g. telephone calls, carer contacts) of over 15 minutes were prospectively recorded. Rates and distributions of these interventions were compared. Results Contact frequency was more than doubled in the ICM group. There wer e proportionately more failed contacts and carer contacts but-there was no difference in the average length of individual contacts or the proportion o f contacts in the patients' homes. Conclusions The failure to demonstrate outcome differences in the UK700 stu dy is not due to a failure to vary the treatment process. UK standard care con-rains many of the characteristics of assertive outreach services and di fferences in outcome may require that greater attention be paid to deliveri ng evidence-based interventions; Declaration of interest None.