Trial of problem solving by community psychiatric nurses (CPNs) for anxiety, depression and life difficulties among general practice patients (the CPN-GP study)

Kendrick, Tony, Simons, Lucy, Thompson, Chris, Mynors-Wallis, Laurence, Lathlean, Judith, Pickering, Ruth and Gerard, Karen (2004) Trial of problem solving by community psychiatric nurses (CPNs) for anxiety, depression and life difficulties among general practice patients (the CPN-GP study). Journal of affective disorders, 78, (Supplement 1), S44-S44.


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Context: Given direct access to (secondary care)
CPNs, UK GPs refer them patients with anxiety,
depression and reactions to life difficulties, but it has
not been established that CPN referral is cost-effective
for these problems, which are often self-limiting.
GP referrals could divert CPNs from the severely
mentally ill and may be an inappropriate use of
scarce resources. However, anxiety and depression
incur enormous suffering and costs in terms of time
lost from work. A previous trial of non-specific CPN
support for such patients suggested referral was no
more effective than usual GP care, but suffered from
a small sample size and high drop-out rate. Specific
therapy may be cost-effective where generic CPN
care is not.
Objectives: To compare the cost-effectiveness of
CPN generic support, specific CPN problem-solving
therapy, and usual GP care.
Design: An RCT with three arms: CPN problem-
solving, generic CPN care, and usual care.
Patients: Practice attenders with at least 4 weeks of
anxiety, depression or reactions to life difficulties.
Outcome measures: Patients were assessed at baseline,
8 and 26 weeks, for symptoms on the CIS-R,
problem severity, social functioning, quality of life,
health service utilisation, and disability days.
Results: CPNs were recruited from four mental
health trusts, and 20 were trained in problemsolving,
with another 20 treating patients with
non-specific support. A total of 75 practices were
recruited, and 245 patients were randomised to the
three arms of the study. The large majority of
patients recovered by the 8-week follow-up. There
were no significant differences found between the
three arms at 8 or 26 weeks in symptoms, social
functioning, or quality of life. Cost data are currently
being analysed and will be presented in
March 2004.
Conclusions: Specialised mental health nurse
support is no better than support from the family
practitioner for patients with milder forms of anxiety,
depression, and life difficulties. Such support
should be reserved for severe and enduring mental

Item Type: Article
ISSNs: 0165-0327 (print)
Related URLs:
Keywords: Netherlands, nurses, anxiety, problem solving, England, depression, community psychiatric nurse, patients, general practice, general-practice, time, community, trial
Subjects: R Medicine > RT Nursing
Divisions : University Structure - Pre August 2011 > School of Medicine > Community Clinical Sciences
ePrint ID: 61875
Accepted Date and Publication Date:
March 2004Published
Date Deposited: 15 Sep 2008
Last Modified: 31 Mar 2016 12:45

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