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.

Abstract

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 illness.

This record has no associated files available for download.

Contributors

Author: Tony Kendrick

Download statistics