Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: randomised control trial
Kendrick, T., Simons, L., Mynors-Wallis, L., Gray, A., Lathlean, J., Pickering, R., Harris, S., Rivero-Arias, O., Gerard, K. and Thompson, C. (2006) Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders: randomised control trial. British Journal of Psychiatry, 189, (1), 50-59. (doi:10.1192/bjp.bp.105.012435).
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Background UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.
Aims To determine the effectiveness and cost-effectiveness of this practice.
Method Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.
Results There were 212 (86%) and190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule - Revised scores at 26 weeks compared with GP care were -1.4 (95% CI -5.5 to 2.8) for generic nurse care, and 1.1 (-2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higherin both nurse-treated groups. Mean extra costs per patient were £283 (95% CI154-411) for generic nurse care, and £315 (183-481) for nurse problem-solving treatment.
Conclusions GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.
|Keywords:||cost-effectiveness referral, community mental health nurses, general practitioner care, common mental disorders, problem-solving treatment|
|Subjects:||R Medicine > RT Nursing
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RM Therapeutics. Pharmacology
|Divisions:||University Structure - Pre August 2011 > Superseded (SONM) > Superseded (HSR)
University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
|Date Deposited:||05 Jul 2006|
|Last Modified:||01 Jun 2011 04:34|
|Contributors:||Kendrick, T. (Author)
Simons, L. (Author)
Mynors-Wallis, L. (Author)
Gray, A. (Author)
Lathlean, J. (Author)
Pickering, R. (Author)
Harris, S. (Author)
Rivero-Arias, O. (Author)
Gerard, K. (Author)
Thompson, C. (Author)
|Contact Email Address:||A.R.Kendrick@soton.ac.uk|
|RDF:||RDF+N-Triples, RDF+N3, RDF+XML, Browse.|
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