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Review: effectiveness of intensive case management for severe mental illness depends on baseline hospital use and organisationCommentary

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T Burns

Correspondence to: Professor T Burns, University of Oxford, Oxford, UK; tom.burns@psych.ox.ac.uk

QUESTION

In people with severe mental illness, what factors influence the effectiveness of intensive case management in reducing time in hospital?

METHODS

Data sources:

Medline, CINAHL, EMBASE/Excerpta Medica, and PsycINFO (to January 2007); Cochrane Central Register of Controlled Trials (Issue 4, 2006); and reference lists.

Study selection and assessment:

randomised controlled trials (RCTs) that compared intensive case management with standard care or low-intensity case management in community-dwelling adults with severe mental disorder (schizophrenia, schizophrenia-like disorder, bipolar disorder, or depression with psychotic features). Excluded were trials involving an acute crisis team; a control condition of hospital admission, remaining in hospital, or an alternate form of intensive case management; patients with mean age <18 or >65 years; and patients with organic brain disorder or learning disability. Trials with inadequate concealment of allocation were also excluded. 29 RCTs (n = 5961, mean age 38 y, 63% men) met the selection criteria and had appropriate outcome data. Of these RCTs, 8 were multicentre trials for which each …

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