The 2-year costs and effects of a public health nursing case management intervention on mood-disordered single parents on social assistance

Markle-Reid, Maureen RegN MScN PhD(C)
Browne, Gina RegN PhD
Roberts, Jacqueline RegN MSc
Gafni, Amiram PhD
Byrne, Carolyn RegN PhD

¹ System-Linked Research Unit on Health and Social Service Utilization and School of Nursing, McMaster University, Ontario, Canada
² System-Linked Research Unit on Health and Social Service Utilization, School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada
³ System-Linked Research Unit on Health and Social Service Utilization, Department of Clinical Epidemiology and Biostatistics and Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada

Correspondence Dr Maureen Markle-Reid, School of Nursing, Faculty of Health Sciences, McMaster University, Room 3N46, 1200 Main Street West, Hamilton Ontario, L8N 3Z5, Canada, E-mail: [email protected]

Accepted for publication: 18 June 2001

Journal of Evaluation in Clinical Practice 8(1):p 45-59, February 2002.

Abstract

Rationale, aims and objectives

This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.

Methods

Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.

Results

At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of $240 000 (Canadian) of costs averted within 1 year for every 100 parents.

Conclusions

In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.