Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study
Abstract Background Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensi...
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-03888-1 |
| _version_ | 1811290503386234880 |
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| author | Tawanchai Jirapramukpitak Kankamol Jaisin Suttha Supanya Patcharapim Takizawa |
| author_facet | Tawanchai Jirapramukpitak Kankamol Jaisin Suttha Supanya Patcharapim Takizawa |
| author_sort | Tawanchai Jirapramukpitak |
| collection | DOAJ |
| description | Abstract Background Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensive case management program (LICM), led by community health workers, on one-year social functioning and service use. Methods A prospective cohort study was conducted on patients aged 18 and above residing in a hospital catchment area. Outcomes were compared between LICM (n = 64) and non-LICM participants (n = 485). A counterfactual framework approach was applied to assess causal effects of the LICM on outcomes. The programme effectiveness was analyzed by augmented-inverse probability of treatment weighting (AIPW) to estimate potential outcome mean (POM) and average treatment effect (ATE). Outcomes were employment status and use of emergency, inpatient and outpatient services. Analyses were stratified by the number of previous psychotic relapse (≤ 1, > 1) to assess heterogeneity of treatment effect on those in an early and later stages of psychotic illness. Results In the early-stage cohort, the likelihood of being employed at one year post-baseline was significantly greater in LICM participants than non-LICM participants (ATE 0.10, 95%CI 0.05–0.14, p < 0.001), whereas service use of all types, except outpatient, was not significantly different between the two groups. In the later-stage cohort, the likelihoods of employment between the two groups at post-baseline were similar (ATE -0.02, 95%CI -0.19–0.15, p = 0.826), whereas service use of all types was significantly higher in LICM participants. Conclusion LICM in a setting where community mental services are scarce may benefit those at an early stage of psychotic illness, by leading to better social functioning and no higher use of unscheduled services at the end of the programme, possibly through their better prognosis and medication adherence. A more intensive case management model may be appropriate for those in a later stage of the illness. |
| first_indexed | 2024-04-13T04:13:51Z |
| format | Article |
| id | doaj.art-e853512d48fc4e72b21673f1dbac2716 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-13T04:13:51Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-e853512d48fc4e72b21673f1dbac27162022-12-22T03:03:03ZengBMCBMC Psychiatry1471-244X2022-04-0122111110.1186/s12888-022-03888-1Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort studyTawanchai Jirapramukpitak0Kankamol Jaisin1Suttha Supanya2Patcharapim Takizawa3Institute for Population and Social Research, Mahidol UniversityDepartment of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol UniversityDepartment of Mental Health, Ministry of Public Health, Somdet Chaopraya Institute of PsychiatryDepartment of Global Public Health, Faculty of Medicine, University of TsukubaAbstract Background Intensive case management (ICM) programmes for psychotic patients are effective in improving outcomes, but often unfeasible in resource-poor settings, as they typically require extensive human resources and expertise. We developed and evaluated the effectiveness of a less intensive case management program (LICM), led by community health workers, on one-year social functioning and service use. Methods A prospective cohort study was conducted on patients aged 18 and above residing in a hospital catchment area. Outcomes were compared between LICM (n = 64) and non-LICM participants (n = 485). A counterfactual framework approach was applied to assess causal effects of the LICM on outcomes. The programme effectiveness was analyzed by augmented-inverse probability of treatment weighting (AIPW) to estimate potential outcome mean (POM) and average treatment effect (ATE). Outcomes were employment status and use of emergency, inpatient and outpatient services. Analyses were stratified by the number of previous psychotic relapse (≤ 1, > 1) to assess heterogeneity of treatment effect on those in an early and later stages of psychotic illness. Results In the early-stage cohort, the likelihood of being employed at one year post-baseline was significantly greater in LICM participants than non-LICM participants (ATE 0.10, 95%CI 0.05–0.14, p < 0.001), whereas service use of all types, except outpatient, was not significantly different between the two groups. In the later-stage cohort, the likelihoods of employment between the two groups at post-baseline were similar (ATE -0.02, 95%CI -0.19–0.15, p = 0.826), whereas service use of all types was significantly higher in LICM participants. Conclusion LICM in a setting where community mental services are scarce may benefit those at an early stage of psychotic illness, by leading to better social functioning and no higher use of unscheduled services at the end of the programme, possibly through their better prognosis and medication adherence. A more intensive case management model may be appropriate for those in a later stage of the illness.https://doi.org/10.1186/s12888-022-03888-1Community health servicesEarly interventionLow and middle-income countriesObservational studiesMental healthPropensity score |
| spellingShingle | Tawanchai Jirapramukpitak Kankamol Jaisin Suttha Supanya Patcharapim Takizawa Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study BMC Psychiatry Community health services Early intervention Low and middle-income countries Observational studies Mental health Propensity score |
| title | Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study |
| title_full | Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study |
| title_fullStr | Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study |
| title_full_unstemmed | Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study |
| title_short | Effectiveness of a community health worker-led case management programme to improve outcomes for people with psychotic disorders in Thailand: a one-year prospective cohort study |
| title_sort | effectiveness of a community health worker led case management programme to improve outcomes for people with psychotic disorders in thailand a one year prospective cohort study |
| topic | Community health services Early intervention Low and middle-income countries Observational studies Mental health Propensity score |
| url | https://doi.org/10.1186/s12888-022-03888-1 |
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