Cost-effectiveness of community psychiatric nurse or out-patient psychiatrist care of neurotic patients

Abstract

SYNOPSISIn a prospective controlled investigation chronic patients, the majority with neurotic conditions, were randomly allocated either to community psychiatric nurses (CPN) as the main therapist or to routine out-patient psychiatrist follow-up. There was no statistically significant difference in the mean public expenditure for the two modes of care. The direct costs of psychiatric care comprised a small proportion of total public expenditure and were initially greater in the nursing group. Subsequently, and over the whole 18-month study period, nursing was the cheaper option in terms of these direct costs. Clinical and social outcomes were comparable in both follow-up groups. Consumer satisfaction was significantly greater among CPN patients. On balance, these results confirm the benefit of community psychiatric nursing for this patient group.

Economic Evaluation of Mental Health Care Interventions. A Review

“…Especially in mental health care, psychosocial costs such as grief and loss of well-being play a major role. Seven studies 1,68,72,78,118,130,145 mentioned these costs as being relevant and tried to fit them into the analysis.…”

“…One can use records available through health service suppliers. 3,56,57,68,69,76,79,102,108,110,116,121,122,127,130,[144][145][146][147] In addition, caseregisters or other macro-level records (e.g. Medicaid records, California County Public Mental Health Information System) can be employed to glean information from several institutions.…”

Estimated costs of neurotic disorder in UK general practice 1985

“…In the field of mental health, there have been numerous economic comparisons of treatment by specialist mental health professionals with the care given by GPs or other types of specialists (Gunderson & Mosher, 1975;Weisbrod et al 1980;Fenton et al 1982;McKechnie et al 1982;Mangen et al 1983;Ginsberg et al 1984;Balestrieri et al 1988). Each presents a distinct choice which is of relevance to health service policy-makers.…”

Family therapy in the home

“…Community psychiatric nurses, in a randomized controlled trial, were shown to bring greater clinical and economic benefits than routine psychiatric outpatient follow-up in the management of adults Family therapy in the home 191 with neurotic disorders (Paykel et al, 1982;Mangen et al, 1983). The patients in this study also showed greater satisfaction with the nursing mode of follow-up and were particularly positive about the fact that the nurses made home visits .…”