Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions

Abstract

Primary care counselling services have expanded rapidly over the last twenty years. Their principal focus has been to manage the demands placed on general practitioners by high service users, such as frequent attenders and patients with mental health problems. To date, very little research has been conducted to ascertain the impact of counselling for other patient groups in terms either of psychological outcomes or of cost-benefits. This study looked at the effect of short-term counselling on both the uptake of health services and the psychological states of four patient groups -frequent attenders and patients with diabetes, hypertension and asthma. All patients on the chronic disease register for these conditions and all patients who had made at least eight GP appointments over the previous twelve months were invited to take part in the study. The participants received eight 90-minute small-group counselling sessions, conducted by trained counsellors. The counselling followed a cognitive behavioural therapy (CBT) approach, with an emphasis on developing personal responsibility. Psychological outcomes were assessed using three proprietary measures (SF 36, HADS and CORE) immediately following counselling and at six months postintervention. Health service uptake was assessed for each group over the twelve months post-intervention, using number of GP consultations, home visits, hospital referrals and test/investigations requested as outcome indicators. These data were compared with those for comparable control groups for each condition. The results suggested that, overall, all patient groups showed a significant improvement in psychological well-being, and that these gains were maintained for the six-month study period. The intervention groups also significantly reduced their uptake of Correspondence: Professor primary and secondary care services, by comparison with their comparable control groups. The results suggest that the psychological and fiscal benefits of counselling provision within a primary care setting can extend to other patient categories.

Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review

“…Subsequently, 52 full-text papers were screened, of which 37 were deemed to be irrelevant. Fifteen papers were identified to be included [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (figure 1).…”

“…There were three main scales found among the papers included, GHQ, 27 28 BDI, 35 39 CORE-OM. 31 36 The other scales reported are Outcome Questionnaire 45 (OQ-45), 26 Hospital Anxiety and Depression Scale (HADS), 31 A Collaborative Outcomes Resource Network (ACORN), 38 Computerised Revised ClinicalInterview Schedule (CRCIS), 39 Short Form 36 Health Survey (SF-36), 31 Center for Epidemiologic Studies Depression Scale (CESD), 27 Hamilton Depression Rating Scale (HDRS17), 35 Brief Symptom Inventory (BSI), 39 Montgomery-Asberg Depression Rating Scale (MADRS) 35 and Skidmore anxiety stigma scale (SASS), 35 although some papers included more than one scale and others did not report a scale at all. Eight papers reported a clinical benefit to integrating MHWs into primary care practices 26-28 31 32 37 38 40 compared with the usual care that a GP would provide, while four papers did not report on these outcomes.…”

“…28 34 Conversely, another study showed a mean increase in GP appointments (6.8-8.4) 26 and another, investigating chronic conditions, showed a significantly reduced rate of health services utilisation (GP appointments, home visits and patient referrals to mental health specialists) after 12 months. 31 Two papers investigated the association between the intervention and the levels of psychotropic drug usage, 28 33 and a further two papers evaluated the general costs associated with the intervention. 39 40 Psychotropic drug usage was found to remain stable during and after the implementation of the intervention in one study, 33 while another reported significantly fewer prescriptions as a result of the intervention.…”

Interventions to Support Integrated Psychological Care and Holistic Health Outcomes in Paediatrics

“…Meta-analyses indicate that psychological interventions reduce care costs by 20% [ 19 ], equating to £1235 per case, and that the cost of psychological treatment is more than offset by the resulting savings in physical healthcare costs [ 18 ]. Considering psychological distress in the context of chronic illness, cognitive behaviour therapy (CBT)-based interventions can improve treatment adherence, psychosocial adjustment, coping skills and quality of life for people with co-morbid LTCs, as well as reducing use of health care services [ 20 , 21 ]; including a psychological component in a breathlessness clinic for Chronic Obstructive Pulmonary Disease (COPD) in adults led to 1.17 fewer A&E presentations and 1.93 fewer hospital bed days per person in the six months after the intervention, which translated into savings of £837 per person [ 22 ].…”

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

“…Various approaches to working with groups in primary care settings have been documented. For example, there have been reports of groups to help with diabetes (Jayasuriya et al, 2000), with various psychiatric conditions (Nickles & McIntyre, 1996) as well as specifically with depression (Finucane & Mercer-Stewart, 2006) and postnatal depression (Honey, Bennett, & Morgan, 2002), with diabetes, hypertension, and asthma (Spurgeon et al, 2005), with smoking cessation (Basler et al, 1992), with social phobia (Huag et al, 2000), and for general well being (Thomas et al, 1997).…”