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CAMHS won't see you now

columnist

The Government's drive to cut hospital admissions has suffered a new blow after a gold standard review cast doubt on the effectiveness of active case management.

The study, on behalf of a Cochrane review group, found there was 'little evidence' from trials of patients with COPD to suggest case management could cut hospital admissions or mortality.

The RCGP said the Government should review its controversial community matrons scheme ­ which uses case management of patients at high risk of admission ­ in light of the new results.

The study, presented at the Society for Social Medicine annual conference in Glasgow this week, reviewed nine international trials in COPD and found no evidence of an effect on mortality at nine to 12 months' follow-up.

Researchers found evidence long-term interventions had not improved patients' health-related quality of life, psychological well-being, disability or pulmonary function, while evidence on admissions was 'equivocal'.

Study leader Dr Stephanie Taylor, senior clinical lecturer at Barts and the London, Queen Mary School of Medicine and Dentistry, said: 'I am not saying case management does not work for COPD, but there is no conclusive evidence that it does work. What evidence does exist does not support it.'

Dr Laurence Buckman, GPC deputy chair, said: 'We know now what these case managers are doing does not benefit anybody. That will

not move the Government one iota.'

Dr Nigel Sparrow, RCGP vice-chair and a GP in Nottingham, said: 'Now would be an opportune moment to review the policy and bring care back to the primary care team.'

Dr Robert McKinley, senior lecturer in general practice at the University of Leicester and a researcher on COPD, said: 'There is an assumption nurses can do most things doctors can do but this needs to be examined.'

But Dr Mo Dewji, clinical director for primary care contracting at the Department of Health and a GP in Milton Keynes, countered: 'I think Government policy has been clear that case management is one of the pillars of chronic disease management.

'I don't think anywhere the Government has said this is the only answer.'

A department spokesman insisted there was evidence case management of high-risk patients 'can improve their lives dramatically and reduce emergency admissions'.

By Nerys Hairon

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