Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: a before and after comparison
- 1Department of Health Care Management and Policy, University of Surrey, Guildford, UK
- 2Centre for Psychological Services Research, ScHARR, University of Sheffield, Regent Court, Sheffield, UK
- 3Hull-York Medical School, University of Hull, Hull, UK
- Correspondence to Dr Tom Chan, Population Health Sciences and Education, St George's, University of London, Canmer Terrace, London SW17 0RE, UK;
Contributors SdeL, principal investigator (PI) for the data linkage project and overall design and responsibility for the project. Developed the analysis plan with TC, drafted the paper outline and made major contributions to subsequent drafts. Liaised with RN over the detail of the study. TC, developed the detailed protocol, managed the ethics and Patient Information Advisory Group application, and made major contributions to writing the paper. GP, PI of NIHR SDO final report and contributed to the paper. KD-B, input into the detailed organisation and running of all stages of the project and contributed to the paper. TK, led the write up of the GP data within the NIHR SDO final report and contributed to the paper.
- Accepted 21 June 2011
- Published Online First 3 October 2011
Background Improving Access to Psychological Therapies (IAPT) is a new programme designed to reduce disease burden to the individual and economic burden to the society of common mental health problems (CMHP). This is the first study to look at the impact of IAPT on health service utilisation and sickness absence using routine data.
Method The authors used pseudonymised secure and privately linked (SAPREL) routinely collected primary, secondary care and clinic computer data from two pilot localities. The authors explored antidepressant prescribing, accident and emergency and outpatients attendances, inpatient stays, bed days, and sick certification. The authors compared the registered population with those with CMHP. The authors then made a 6 months before and after comparison of people referred to IAPT with age–sex and practice-matched controls.
Results People with CMHP used more health resources than those without CMHP: more prescriptions of antidepressants 5.25 (95% CI 5.38 to 5.13), inpatient episodes 4.89 (95% CI 5.0 to 4.79), occupied bed days 1.25 (95% CI 0.95 to 1.55), outpatient 1.5 (95% CI 1.40 to 1.63) and emergency department attendances 0.34 (95% CI 0.31 to 0.37), and medical certificates 0.29 (95% CI 0.26 to 0.32). Comparison of service utilisation 6 months before and after referral to IAPT was associated with reduced use of emergency department attendances (mean difference: 0.12 (95% CI 0.06 to 0.19, p<0.001)). However, the number of prescriptions of antidepressants increased mean difference −0.15 (95% CI 0.02−0.29, p=0.028).
Conclusions People with CMHP use more healthcare resources. Referral to the IAPT programme is associated with a subsequent reduction in emergency department attendances, sickness certification and improved adherence to drug treatment.
- Behavioural disciplines and activities
- medical record systems
- healthcare disparities
- healthcare quality
- family practice
- access and evaluation
- mental disorders
- depressive disorders
- anxiety disorders
- community care
- health policy
- health service use
- mental health inequalities
- prim/sec interface
Funding Practices and patients for the use of their pseudonymised data. This study was funded by the National Institute for Health Research, Service Delivery and Organisation Programme (NIHR SDO) programme as part of a wider evaluation of Improving Access to Psychological Therapies (IAPT) demonstration sites. The pseudonymisation and data linkage, SAPREL (Secure and Private Record Linkage) was carried out by Sapior Ltd and funded by the DH IAPT programme and was described in a separate protocol and ethics application.
Competing interests None.
Ethics approval This study was conducted with the approval of The National Research Ethics Service (No. 08/H0715/101) and by the former Patient Information Advisory Group.
Provenance and peer review Not commissioned; not externally peer reviewed.