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Psychological therapies 'help patients control long-term conditions'

GP referral for depression and anxiety in patients with a long-term condition (LTC) can significantly improve their control of their disease and healthcare costs, suggest UK researchers.

The study across 20 GP practices showed a reduction in A&E department use and increased antidepressant use in people with LTCs and common mental health problems who had been referred to the Improving Access to Psychological Therapies (IAPT) programme, compared with those who were not referred to an IAPT service.

The team concluded that while further research over longer periods is needed, it seems that IAPT helps people with LTCs cope with their physical as well as comorbid mental health problems.

Launched nationally in 2008, the IAPT programme is aimed at expanding the use of evidence-based psychological therapies for common mental health problems such as depression and anxiety. A study published in 2011 found that the IAPT programme resulted in a significant reduction in sick notes and A&E attendances among people with such conditions.

This latest analysis, published in Behaviour Research and Therapy, looked at the use of healthcare by 1,118 people with a common mental health problem referred to IAPT, of whom 186 had LTCs, and that of 6,711 matched control patients with a common mental health problem who were ot referred to IAPT, of whom 1,115 had a LTC.

People with LTCs and mental health problems who were referred for IAPT had a fall in A&E service attendances in the six months after referral, compared with the six months before, whereas those who were not referred to IAPT had an increase in A&E attendance over the same period. This equated to an average of 0.21 fewer A&E visits with IAPT versus no IAPT, a statistically significant difference.

The group with LTCs referred for IAPT also had a significant increase in antidepressant prescriptions in the six months after compared with before referral, with a mean increase of 0.62 prescriptions over and above that seen among patients with LTCs and comorbid mental health problems who were not referred to IAPT. The authors say this suggests that psychological therapies led to better adherence to antidepressant medications.

There was also a numeric decrease in the number of bed days and increase in outpatient use in those patients with LTCs referred to IAPT relative to those who were not, but these changes were not statistically significant.

The researchers concluded: ‘Referral to IAPT seems to be appropriate for people with LTCs and common mental health problems.

‘It is plausible that the act of referral, which requires acknowledgement that there may be a health benefit from treating a psychological component of their illness, may help provide insight and be therapeutic.’

They added: ‘It is possible that improving psychological health either directly improves physical health or patients’ ability to cope with symptoms from their LTC.’

Study author Professor Tony Kendrick, professor of primary medical care at Southampton University, said: ‘I think it’s important that commissioners realise that tackling anxiety and depression can improve physical health too and consider the reduction in health service use that IAPT services can help bring about.’

Dr Gabriel Ivbijaro, a GP in North London and Chair of the WONCA Working Party on Mental Health, said: ‘Obviously many people with LTCs suffer from depression as a comorbidity and are more anxious.

‘If you can deal with this aspect of their illness, they are less likely to present at hospital, so it makes sense. They are able to cope better, less stressed about things and able to rationalise what’s happening and that’s probably why this improves.’

Dr Ivbijaro added: ‘IAPT in LTCs is still quite a new thing. We do have these services, but we need to highlight it so many more people can be referred.

‘Some people need only two sessions, some 30 – we need to tailor it to peoples’ needs.’

Behav Res Ther 2013; 51: 377–385

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