Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach
Background: This study focuses on health care received by people with serious mental illness (SMI). The aim is to examine the economic implications of different locations of management of care and the views of service users and staff regarding services set up as alternatives to secondary care. Objec...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
National Institute for Health Research
2016-12-01
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| Series: | Health Services and Delivery Research |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/hsdr04340 |
| _version_ | 1828349272870879232 |
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| author | Paul McCrone Steve Wright Darshan Zala Muralikrishnan Radhakrishnan Kartha Leonardo Koeser Mark Ashworth Peter Schofield Diana Rose Sarah Corlett Anita Patel Robert Stewart Daniel Stahl David Whitney Julia Gannon |
| author_facet | Paul McCrone Steve Wright Darshan Zala Muralikrishnan Radhakrishnan Kartha Leonardo Koeser Mark Ashworth Peter Schofield Diana Rose Sarah Corlett Anita Patel Robert Stewart Daniel Stahl David Whitney Julia Gannon |
| author_sort | Paul McCrone |
| collection | DOAJ |
| description | Background: This study focuses on health care received by people with serious mental illness (SMI). The aim is to examine the economic implications of different locations of management of care and the views of service users and staff regarding services set up as alternatives to secondary care. Objectives: Specific objectives are to (1) identify people with SMI managed in primary or secondary care; (2) identify those who could be potentially transferred to primary care; (3) compare the characteristics of these groups; (4) compare service use and costs; (5) generate models to estimate cost changes following transfer between settings; (6) identify characteristics associated with time to transition to secondary care; (7) investigate experiences of patients receiving support from community-based interventions; and (8) assess the economic impact of interventions to facilitate transfer of care management. Methods: (1) Quantitative component – using linked primary and secondary care data we examined differences between those discharged to primary care (n = 1410) and those still in secondary care (n = 1629). Service use and costs were compared and predictors of costs were identified using regression models. (2) Qualitative component – interviews following a topic guide were conducted at two time points with 31 people using and 10 people working in services set up as alternatives to secondary care. (3) Economic modelling – an analysis of the health-care costs of the above services compared with usual care was conducted using decision modelling. Data were obtained from local services where possible, and the time horizon was 12 months. Results: (1) Quantitative component – characteristics of those discharged to primary care (n = 1410) were similar to those still in secondary care (n = 1629). Costs for those discharged to primary care were 48% lower than for those remaining in secondary care. Other variables strongly associated with costs were a history of violence and a diagnosis of schizophrenia or bipolar disorder. Few patients in secondary care had a high probability of primary care management and, therefore, excess costs were only around £150,000 across the sample. (2) Qualitative component – service users’ views about a community options team and a primary care support service were positive and compared favourably to services used previously. Views about peer support were slightly less consistent. Staff had concerns with regard to caseload sizes and staff turnover. (3) Economic modelling – services to help transition had costs that were 40% of those for standard care. The results of this showed that triaging patients into these services would save £1578 over a 1-year period and that the results were robust to changes in most parameters. Limitations: Analysis was hindered by the extent to which data were available. Qualitative analyses were limited by the fact that most of the participants did not have a SMI as usually defined and that many had been out of contact with secondary services for a long period of time. Conclusions: Costs are substantially lower in primary care than secondary care, even after controlling for service-user patient differences. Generally, there is satisfaction with services to help facilitate primary care provision and these appear to be cost saving. Future work should continue the analysis of linked data and involve a more comprehensive evaluation of the specific services investigated here. Funding: The National Institute for Health Research Health Services and Delivery Research programme. |
| first_indexed | 2024-04-14T01:07:04Z |
| format | Article |
| id | doaj.art-51b3cb7897094d16b77ad60459e612bd |
| institution | Directory Open Access Journal |
| issn | 2050-4349 2050-4357 |
| language | English |
| last_indexed | 2024-04-14T01:07:04Z |
| publishDate | 2016-12-01 |
| publisher | National Institute for Health Research |
| record_format | Article |
| series | Health Services and Delivery Research |
| spelling | doaj.art-51b3cb7897094d16b77ad60459e612bd2022-12-22T02:21:11ZengNational Institute for Health ResearchHealth Services and Delivery Research2050-43492050-43572016-12-0143410.3310/hsdr0434011/1023/13Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approachPaul McCrone0Steve Wright1Darshan Zala2Muralikrishnan Radhakrishnan Kartha3Leonardo Koeser4Mark Ashworth5Peter Schofield6Diana Rose7Sarah Corlett8Anita Patel9Robert Stewart10Daniel Stahl11David Whitney12Julia Gannon13Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKHealth Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKHealth Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKHealth Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKHealth Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKDivision of Health & Social Care Research, King’s College London, London, UKDivision of Health & Social Care Research, King’s College London, London, UKHealth Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKLambeth and Southwark Public Health Department, London, UKCentre for Primary Care and Public Health, Queen Mary University of London, London, UKPsychiatric Epidemiology and Clinical Informatics, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKDepartment of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UKDivision of Health & Social Care Research, King’s College London, London, UKContracts, South London and Maudsley NHS Foundation Trust, London, UKBackground: This study focuses on health care received by people with serious mental illness (SMI). The aim is to examine the economic implications of different locations of management of care and the views of service users and staff regarding services set up as alternatives to secondary care. Objectives: Specific objectives are to (1) identify people with SMI managed in primary or secondary care; (2) identify those who could be potentially transferred to primary care; (3) compare the characteristics of these groups; (4) compare service use and costs; (5) generate models to estimate cost changes following transfer between settings; (6) identify characteristics associated with time to transition to secondary care; (7) investigate experiences of patients receiving support from community-based interventions; and (8) assess the economic impact of interventions to facilitate transfer of care management. Methods: (1) Quantitative component – using linked primary and secondary care data we examined differences between those discharged to primary care (n = 1410) and those still in secondary care (n = 1629). Service use and costs were compared and predictors of costs were identified using regression models. (2) Qualitative component – interviews following a topic guide were conducted at two time points with 31 people using and 10 people working in services set up as alternatives to secondary care. (3) Economic modelling – an analysis of the health-care costs of the above services compared with usual care was conducted using decision modelling. Data were obtained from local services where possible, and the time horizon was 12 months. Results: (1) Quantitative component – characteristics of those discharged to primary care (n = 1410) were similar to those still in secondary care (n = 1629). Costs for those discharged to primary care were 48% lower than for those remaining in secondary care. Other variables strongly associated with costs were a history of violence and a diagnosis of schizophrenia or bipolar disorder. Few patients in secondary care had a high probability of primary care management and, therefore, excess costs were only around £150,000 across the sample. (2) Qualitative component – service users’ views about a community options team and a primary care support service were positive and compared favourably to services used previously. Views about peer support were slightly less consistent. Staff had concerns with regard to caseload sizes and staff turnover. (3) Economic modelling – services to help transition had costs that were 40% of those for standard care. The results of this showed that triaging patients into these services would save £1578 over a 1-year period and that the results were robust to changes in most parameters. Limitations: Analysis was hindered by the extent to which data were available. Qualitative analyses were limited by the fact that most of the participants did not have a SMI as usually defined and that many had been out of contact with secondary services for a long period of time. Conclusions: Costs are substantially lower in primary care than secondary care, even after controlling for service-user patient differences. Generally, there is satisfaction with services to help facilitate primary care provision and these appear to be cost saving. Future work should continue the analysis of linked data and involve a more comprehensive evaluation of the specific services investigated here. Funding: The National Institute for Health Research Health Services and Delivery Research programme.https://doi.org/10.3310/hsdr04340mental illnesspsychiatryprimary careeconomicshealth-care utilisationcosts and cost analysiseconomic evaluationdecision analysisqualitative research |
| spellingShingle | Paul McCrone Steve Wright Darshan Zala Muralikrishnan Radhakrishnan Kartha Leonardo Koeser Mark Ashworth Peter Schofield Diana Rose Sarah Corlett Anita Patel Robert Stewart Daniel Stahl David Whitney Julia Gannon Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach Health Services and Delivery Research mental illness psychiatry primary care economics health-care utilisation costs and cost analysis economic evaluation decision analysis qualitative research |
| title | Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach |
| title_full | Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach |
| title_fullStr | Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach |
| title_full_unstemmed | Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach |
| title_short | Location of care for people with serious mental illness (LOCAPE): implications for service use and costs using a mixed-methods approach |
| title_sort | location of care for people with serious mental illness locape implications for service use and costs using a mixed methods approach |
| topic | mental illness psychiatry primary care economics health-care utilisation costs and cost analysis economic evaluation decision analysis qualitative research |
| url | https://doi.org/10.3310/hsdr04340 |
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