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IAPT reduces A&E visits and sick notes

Referring patients with depression for talking therapies reduces A&E attendances, gets people back to work and improves adherence to antidepressant medication, say the authors of a major UK analysis.

Their study - the first to link treatment under the Improving Access to Psychological Therapies with reduced overall healthcare service usage – shows the Government's flagship programme could help to reduce the cost to society and the NHS of psychological illness.

It comes despite recent warnings over a ‘postcode lottery' in IAPT service provision, with three quarters of the 145 PCTs providing the services falling short of the Government's 50% ‘recovery rate' target – with some reporting success rates as low as 6%.

The analysis, published in the journal of Epidemiology and Community Health, reviews data on 152,000 patients from GP lists in London and Yorkshire between 2007 and 2009.

hey found around 10% of the adult study population had a common mental health problem such, as anxiety or depression, in the 18 month study period.

Compared with matched controls - who had a mental health problem but were not referred to IAPT – they found IAPT referral was associated with a statistically significant reduction in the number of sick notes and A&E attendances, with mean differences of 0.11 and 0.12 between groups.

There was also a reduction in the number of inpatient admissions and the number of occupied bed days in the IAPT group, although these changes were not statistically significant.

There was a statistically significant increase in the prescription of antidepressants in the IAPT group compared with controls (mean difference of 0.15) which the authors suggest may reflect better compliance with therapy.

Lead author Professor Simon de Lusignan, a GP in Guildford and chair in healthcare management at the University of Surrey, said: ‘At a time when there is pressure to control increasing health costs, this study suggests that IAPT may contribute to reducing health service usage.'

‘Across the board, GPs are struggling to try and match people's needs with available services. But if you get evidence of benefit [of IAPT] it may be prioritised by commissioners ahead of other services.'

Dr Jonty Heaversedge, a GP in South London with an interest in mental health. welcomed the analysis, but said it needed more evidence of cost-effectiveness.

'It doesn't incorporate the cost of IAPT to see if it balances out,' he said.

J Epidemiol Community Health. Online first 3 October 2011

 

How IAPT referral reduces healthcare usage

 

Measure

Mean change

Antidepressant prescriptions

+0.15*

Admissions

-0.04

Outpatient attendances

-0.16

A&E attendances

-0.12*

*statistically significant change

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