Psychiatry Management Research Articles

Does Case Management Work? The Evidence and the Abuse of Evidence-Based Medicine

This study reviews typologies of psychiatric case management and then discusses the efficacy, effectiveness and cost effectiveness of psychiatric case management, with particular focus on evidence from Australia and the UK. Subsequently, it aims to examine the way such evidence has been interpreted in the context of UK psychiatric research and services. Finally it examines the ways in which, by the selective reviewing or editorializing of evidence, case management has been brought into disrepute in the UK. This study reviews literature of the recent evidence for case management, and asks three questions of case management: has it been shown to be efficacious in controlled research, is it effective in applied settings, and is it cost effective? An examination is then made of the concurrent representations of the UK evidence in both the academic literature and the media. There is strong evidence for the efficacy effectiveness and cost-effectiveness of case management in psychiatry, the closer it conforms to active and assertive community treatment models. It appears, however, that studies and evidence-based reviews of case management have possibly been misused and misrepresented in a highly charged atmosphere of professional media debate. The potential for this abuse is not limited to psychiatry and remains a challenge for all evidence-based practice. On the evidence, assertive community treatment case management is one of the most effective interventions in psychiatry today. Despite improving the evidence base for practice (e.g. as has occurred for case-management in psychiatry), evidence-based medicine (EBM) is still susceptible to compromise and misrepresentation, due to unexamined or undeclared bias. Unless this potential for abuse is recognized and checked, EBM in psychiatry is in danger of being discredited at the hand of some of its own proponents. There is a need for more rigorous pursuit of evidence-based psychiatry, including more systematic declaration of bias in all research, whether quantitative or qualitative in design.

PQM--Psychiatry Quality Measurement.

As a consequence of an increased awareness of quality management in psychiatry the Lundbeck Institute has developed a software program called Psychiatry Quality Measurement (PQM). This is an electronic documentation and quality measurement system with a large data-collecting function to record longitudinal data of the full psychiatric visit, covering all aspects of an evaluation and follow-up. Using the full ICD-10 and DSM-IV classifications, the system has been designed to assist with quality measurement in all psychiatric diagnoses. A full statistical package is included in the program to calculate outcomes of treatment (including relapse rates, improvements in psychopathology, severity and frequency of side-effects, and costs of treatment) as tables and graphs ready for presentation in a Powerpoint format. The system is fully translatable and flexible for various implementation settings, including stand-alone PCs or hospital network systems, all ICD-10 or DSM-IV diagnoses, and the possibility of the use of over 20 psychopathology and side-effect scales to measure the quality of care of all psychiatry patients.

Quality management in psychiatry.

Over the past 50 years, treatment possibilities in psychiatry have drastically improved, but the results we actually achieve under everyday treatment conditions fall far short of what could be accomplished. Quality management represents a suitable method of reducing this gap. Although it has been successfully practiced in other medical disciplines for a long time, its implementation in psychiatry has previously been restricted to pilot projects. Quality management programs in psychiatry have been slow to be accepted because, up to now, only a few mental health professionals have received training in quality management techniques. In order to compensate for this information deficit and to familiarize psychiatrists and other mental health care workers with this increasingly important topic, we will provide in this paper a brief survey of the most important principles and techniques of quality management. This information should encourage psychiatrists to apply this new method to their own areas of responsibility. The results of one of our own studies on schizophrenic outpatients, which are presented at the end of the paper, are intended to show that the outcome can be improved and costs reduced by implementing quality management programs in psychiatry.

Assessment of therapy outcome within the scope of quality assurance in a psychiatric clinic. A report of experiences

A recent modification of German law requires quality assurance of inpatient treatment, i.e., of the quality of therapy, allowing comparison of different hospitals. In this paper a program developed to assess the outcome by means of international, frequently applied psychopathometric scales is presented. This program was evaluated in a study of 258 psychiatric inpatients. This study emphasized the identification of patients with long-term hospitalization and/or worse outcome. A concept to disclose these so-called 'problematic' patients by means of easily administered scales like the SCL90-R, GAF and WHO-Disability-Diagnostic-Scale (DDS) has been developed. Patients with a very long hospital stay (> 70 days) show a higher number and more severe symptoms in the self-rating (SCL90-R) at admission than the subjects with a short hospital stay. This pilot study demonstrated that a routine outcome analysis can be used for quality management in psychiatry.

Risk assessment and management in psychiatric practice: inferring predictors of risk. A view from learning disability

Concepts of risk assessment and management in psychiatry increasingly reflect public and professional anxieties that people with a mental disorder may harm others. The increase in likelihood, over the general population, of suicide is also fairly high in consciousness. For people with learning disabilities such risks will need managing from time to time but they appear no higher than for the general population, possibly rather lower. Other risks are much more prominent, best summarized as risks to those with learning disability from society. The double edge sword of 'prevention' through genetic counselling and its likely consequences cannot be ignored, but here special attention is given to risks of experience of physical and/or sexual abuse and risks of miscarriages of justice.

Case management in psychiatry: an analysis of tasks.

The authors analyze the concept of case management from the perspective of the task areas of psychiatry and demonstrate the importance of case management in the organization of psychiatric services. The relevant literature was reviewed, and a functional analysis of current practices is provided. Case management is an ambiguous concept without a clear base in a professional discipline, and thus there is ongoing uncertainty about its mission, practice, and training, as well as authority and accountability issues. The activities of the case manager in both the private and the public sectors entail work in the task areas of medical care, rehabilitation, social control, growth and development, and social welfare. In all of these areas, the case manager may function in boundary management and in system enhancement and development as well as provide clinical services. Case management has considerable potential as a means of organizing and delivering mental health services in a cost-effective manner as long as its purpose, practice, and organizational structures are consistent. Psychiatrists should be involved in the organization of case management services.

Clinical risk management in psychiatry

Clinical risk management in psychiatry

Clinical risk management in psychiatry.

Clinical risk management in psychiatry.

Risk Management in Psychiatry

This article introduces some basic concepts of psychiatric risk management and demonstrates how risk management and quality assurance can work together. Risk exposure areas and loss prevention issues identified during a review of 98 psychiatric claims managed from 1976 to 1988 by the Risk Management Foundation of the Harvard Medical Institutions are detailed.

Participatory management in psychiatry.

In psychiatry, the concept of participatory management has been developed in the therapeutic community and elsewhere. The industrial management literature reveals that, although scientific management and human relations theorists saw no necessary conflict between management and worker, more recent writers have noted great conflict between organizational and individual needs. The author attempts to translate the industrial experience to psychiatric bureaucracies and highlights the basic conflicts between participatory management and authority, responsibility, and conflicting value systems.