Enhancing recovery rates: Lessons from year one of IAPT

Abstract

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Is interpersonal counselling (IPC) sufficient treatment for depression in primary care patients? A pilot study comparing IPC and interpersonal psychotherapy (IPT)

“…Comparison of the results with those of practice-based studies in routine service settings is more complicated, because the recovery rates depend upon how the sample is chosen (Barkham et al, 2012). However, the present outcome results exceeded those of the selected completers' group in practice-based studies, where 40-58% had recovered (Richards & Borglin 2011, Gyani et al, 2013, Holmqvist et al, 2014.…”

“…Practice-based studies in routine service settings have similarly shown short-term psychotherapeutic treatment to be effective, with 40-58% of the patients who completed the treatment recovering (Gyani et al, 2013;Holmqvist et al, 2014;Richards & Borglin 2011, Stulz et al, 2013. Systematic studies of the ideal dosage of short-term psychotherapy for gaining the optimal outcome are rare, however.…”

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