This is the latest updated volume in a well-established series bringing together information from a variety of sources to estimate national unit costs for a wide range of health and social care services. This report consists of tables for more than 130 types of service which, as well as providing the most detailed and comprehensive information possible, also quotes sources and assumptions so users can adapt the information for their own purposes. This year we have included a guest editorial on ‘Big Data’: increasing productivity while reducing costs in health and social care and three short articles on The cost of integrated care; Shared lives – improving understanding of the costs of family-based support and the costs of providing a group intervention to people with dementia and their family carers:SHIELD: RYCT & CSP intervention costs (Remembering Yesterday Caring Today and Carer Support Programme). There are also several new schema providing the costs of: advocacy for people with learning disabilities; a hospice rapid response service; the early years classroom management programme; residential parenting assessments; independent review officers; time banks; dentists and care home costs for people with dementia. The 2014 edition is also available in full, free of charge, at the PSSRU website www.pssru.ac.uk/unit-costs/2014/ as an Acrobat file.

Unit Costs of Health and Social Care 2014

Background: 
Little is known about the extent to which work contributes to the recovery of people with schizophrenia. There is increasing interest in the subject because of new service models and the economic cost of unemployment in people with severe mental illness.
Methods: 
A literature search was carried out with the aim of investigating: a) employment rates in schizophrenia and first-episode psychosis and the extent to which they have changed over time; b) the barriers to work; c) the factors associated with being employed among people with schizophrenia; and d) whether employment influences other outcomes in schizophrenia.
Results: 
There are wide variations in reported employment rates in schizophrenia. Most recent European studies report rates between 10 % and 20%, while the rate in the US is less clear. There is a higher level of employment among first-episode patients. The employment rate in schizophrenia appears to have declined over the last 50 years in the UK. Barriers to getting employment include stigma,discrimination, fear of loss of benefits and a lack of appropriate professional help. The most consistent predictor of employment is previous work history. Working is correlated with positive outcomes in social functioning, symptom levels, quality of life and self esteem, but a clear causal relationship has not been established.
Conclusions: 
Very low employment rates are not intrinsic to schizophrenia, but appear to reflect an interplay between the social and economic pressures that patients face, the labour market and psychological and social barriers to working.

Schizophrenia and employment - A review

Unit Costs of Health and Social Care 2018

Background Little is known about international variations in employment rates among people with schizophrenia or about the factors associated with employment in this disorder.Aims To describe employment patterns and the variables associated with working in an international sample of people with schizophrenia.Method An analysis was made of baseline data from the European Schizophrenia Cohort study, a 2-year investigation of people with schizophrenia in contact with secondary services and living in France, Germany and the UK (n=1208).Results Participants were working in all sections of the job market. People who had a degree, were living with their families or had experienced only a single episode of illness were more likely to be working. A continuous illness course, more severe non-psychotic symptoms and drug misuse reduced the odds of employment. There were large variations between centres in employment rates, which were highest in the three German study sites. These differences persisted after adjustment for individual characteristics.Conclusions Local social contexts may be as important as individual or illness-related factors in explaining employment status.

/pdf/rates-and-correlates-of-employment-in-people-with-wjy5s26t9i.pdf

Rates and correlates of employment in people with schizophrenia in the UK, France and Germany

Adjustment for baseline variables in a randomized trial can increase power to detect a treatment effect. However, when baseline data are partly missing, analysis of complete cases is inefficient. We consider various possible improvements in the case of normally distributed baseline and outcome variables. Joint modelling of baseline and outcome is the most efficient method. Mean imputation is an excellent alternative, subject to three conditions. Firstly, if baseline and outcome are correlated more than about 0.6 then weighting should be used to allow for the greater information from complete cases. Secondly, imputation should be carried out in a deterministic way, using other baseline variables if possible, but not using randomized arm or outcome. Thirdly, if baselines are not missing completely at random, then a dummy variable for missingness should be included as a covariate (the missing indicator method). The methods are illustrated in a randomized trial in community psychiatry.

Adjusting for partially missing baseline measurements in randomized trials.

Background Case management, particularly in intensive form, has been widely introduced for the treatment of severe mental illness. However, the optimal intensity of case management has not been determined. Aims We aimed to assess whether intensive case management (small case load) reduces hospitalisation and costs compared with standard case management. Method Development and rationale of a large randomised controlled trial comparing intensive case management (case load per worker? 15 patients) with standard case management (case load 30–35 patients) Results Two-year outcome data will be obtained on patients representative of the seriously mentally ill in inner-city mental health services. Conclusions The study planned with 700 patients should be sufficient to detect small differences in the readmission of patients to hospital (10%), the number of days spent in hospital over a two-year period (10 days) and the average weekly cost of care per patient. The sample is large enough to compare the cost-effectiveness of intensive and standard case management in mild and severe disability and in people of African–Caribbean origin and White Caucasians.

Comparison of intensive and standard case management for patients with psychosis - Rationale of the trial

COVID-19 lockdown measures led to the suspension of centre-based cardiac rehabilitation (CR). We aimed to describe the impact of lockdown on CR behaviours and perceptions of efficacy in a sample of CR participants.An online survey was conducted amongst CR participants from May to October 2020, COVID-19-related lockdown restrictions. Anthropometric data, participant-determined levels of motivation and self-perceived efficacy, CR practices etc., pre- and post-lockdown, were collected.The probability of practicing CR in public gyms and hospitals decreased 15-fold (47.2% pre-, 5.6% post-lockdown; OR[95% CI] 0.065[0.013; 0.318], p < 0.001), and 34-fold (47.2% pre, 2.8% post; OR[95% CI] 0.029[0.004; 0.223], p < 0.001), respectively. Amongst participants, 79.5% indicated that their CR goals had changed and were 78% less likely to engage in CR for socialization after lockdown (47.2% pre, 16.7% post; OR[95% CI] 0.220[0.087; 0.555]; p = 0.002). The probability of receiving in-person supervision decreased by 90% (94.4% pre, 16.7% post; OR[95% CI] 0.011[0.002; 0.056]), while participants were almost 7 times more likely to use online supervision (11.1% pre, 44.4% post; OR[95% CI] 6.824[2.450; 19.002]) (both p < 0.001). Fifty percent indicated that their enjoyment of CR was lower than before lockdown and 27.8% reported they would be less likely to continue with CR in the newer format.Lockdown was associated with considerable changes in how CR was practiced, motivation levels and willingness to continue with CR. Further research is warranted to develop and improve strategies to implement in times when individuals cannot attend CR in person and not only during pandemics. 

/pdf/impact-of-covid-19-lockdown-restrictions-on-cardiac-3fc21ie6.pdf

Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom

<h3>Background</h3> The cardioprotective diet is effective in reducing risk of mortality and morbidity in patients with heart disease. Therefore, high-quality dietary education in UK cardiac rehabilitation (CR) is needed. However, little is known about its provision in UK CR. <h3>Aim</h3> Understand dietary education provision in UK-based CR: (1) Who delivers it? (2) How is it delivered? and (3) What does it include? <h3>Methods</h3> A voluntary, electronic survey (Online Surveys, Jisc, UK) was disseminated in conjunction with the BACPR, between July and October 2021. Providers of dietary education in UK-based CR were eligible to participate. Survey questions related to the profession and qualifications of education providers, and the resources used, content and delivery method of dietary education sessions. <h3>Results</h3> There were 49 eligible responses from CR centres, delivering early CR (77.6%), maintenance CR (6.1%) or both (16.3%). Dietary educators included; dietitians (55.1%), specialist nurses (65.3%), and exercise professionals (16.3%). 46.9% of educators had no formal nutrition-related qualifications. A median of two (Range, 1 to 12) diet sessions was provided per CR programme. Most had a cardioprotective diet focus. Resources include British Heart Foundation booklets (93.9%) and the Eatwell Guide (69.4%). Diet history assessment methods varied between centres, with one fifth performing no assessment at the start of the programme; citing lack of time (70.0%), staff (20.0%) or knowledge (30.0%). Frequently, no specific amount of carbohydrate (75.5%), fat (63.3%) or protein (75.5%) was recommended. Comorbidities were used to tailor individual advice or referred to a specialist (figure 1). 87.3% of centres followed up whether advice was implemented by patients. <h3>Conclusion</h3> CR programmes consistently include key components of a cardioprotective diet and account for known risk factors in dietary advice. However, many failed to assess diet at baseline. Increased training of practitioners, and time allocated to dietary education in CR, programmes is needed. 

/pdf/28-provision-of-dietary-education-in-uk-based-cardiac-1d6rj5ls.pdf

Tom Butler

Papers

Comparison of intensive and standard case management for patients with psychosis - Rationale of the trial

Impact of COVID-19 lockdown restrictions on cardiac rehabilitation participation and behaviours in the United Kingdom

28 Provision of dietary education in UK-based cardiac rehabilitation: a cross-sectional survey