Case Management Advocates Redfaced As Cochrane Exposes Flaws – 5 February 1999

“A 1998 study produced by the Cochrane Library has determined that there is no evidence that case management improves the outcomes in mental health”, said spokesperson for the Australian Doctors’ Fund, Dr Shirley Prager.

Dr Prager said “the study conducted by Marshall, Gray, Lockwood & Green and dated 1 December 1997 also claims that case management ‘doubled the numbers admitted to psychiatric hospitals’ which is bad news for those advocates who have sprouted the false belief that case management would lessen the reliance on expensive hospitalisation”.

The study compared case management to traditional standard medical care on four indices (i) number remaining in contact with psychiatric services; (ii) Extent of psychiatric hospital admissions; (iii) clinical and social outcome; and (iv) costs.

The researchers concluded that “case management is an intervention of questionable value, to the extent that it is doubtful whether it should be offered by community psychiatric services”.

The researchers then say “It is hard to see how policy makers who subscribe to an evidence based approach can justify retaining case management as ‘the cornerstone’ of community mental health care.

“Dr Wooldridge, Australia’s self proclaimed Evidence Based Medicine guru, should take note of this evidence. Dr Wooldridge’s plans for an Integrated Mental Health Services Project as a cure all for public psychiatric services are just more case management projects. Expensive, clinically interfering, managed care like projects that cost more to deliver and are less effective in treatment”.

“The Federal Government is gung-ho on co-ordinated care for older Australians. What they mean is that they wish to co-ordinate what care will and will not be available. Once removed from Medicare these people may be subject to budget holding and rationing as administration budgets eat into the pool of treatment money”.

“Co-ordinated care, case management, and managed care are all synonyms for third party intervention in clinical care. They all place a middle layer of bureaucracy between doctors and patients and increase the costs of care” Dr Prager said.