Psychiatric case management in a tertiary psychiatric hospital
- Author:
Rathi Mahendran
;
Margaret Hendricks
;
Chan Yiong Huak
;
Vamadevan Thambyrajah
;
Thamilselvi Vellayan
;
Saifudin Maarof
- Publication Type:Journal Article
- Keywords:
brokerage model, psychiatric case management, psychiatric hospital
- From:ASEAN Journal of Psychiatry
2008;9(1):25-32
- CountryMalaysia
- Language:English
-
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
