This research study has now been published in PLoS ONE.
Aims
IAPT promotes access to talking treatments based on cognitive behavioural therapy (CBT), which are approved by NICE (the National Institute for Health and Clinical Excellence). There are two tiers of IAPT therapy, depending on clinical severity, and corresponding to NICE steps 2 and 3 for the treatment of depression and anxiety. More intense therapy is delivered by more experienced clinicians in the higher tier; the lower tier provides treatment for the majority of referrals from primary care and other sources. Telephone mediated psychological interventions are convenient for patients and therapists, with a 40% reduction in treatment time and removal of barriers to treatment initiation, especially for patients receiving low intensity therapy. Services are no longer constrained by working hours or treatment space. However, the evidence for these benefits relies on small samples in specialised settings, and may not be relevant to the relatively brief interventions (fewer than six sessions) delivered in the lower tier of IAPT. To address this uncertainty, we assessed the clinical and cost effectiveness of low intensity talking therapies, delivered face-to-face (FTF) versus over the telephone (OTT) in the IAPT programme in East of England region.
Methods
Observational study of routine patient-reported clinical outcomes collected at each session on individuals being treated using CBT-based psychological therapies. Participant and service-level characteristics were controlled using stratification and one-to-one matched propensity scores. We used a non-inferiority comparison to assess clinical effectiveness and performed a cost-minimisation analysis to assess cost-effectiveness.
Outcomes
The clinical effectiveness of low intensity CBT-based interventions delivered over the telephone was equivalent to those delivered face-to-face. The per-session cost for OTT was lower than FTF, suggesting that OTT is cost-effective, providing the potential for significant financial savings in this context. Delivering interventions OTT has opened up the IAPT service to groups of people who might otherwise be unable to access the IAPT service either through transport problems, physical disability, work commitments, or perhaps a reluctance to talk face to face about their about personal issues. On the back of these findings, the East of England Strategic Health Authority has instigated a regional training programme to ensure the East of England therapists are competent at telephone contact with patients and to standardise delivery across all services. An academic paper for peer-reviewed publication has been submitted and is under review.
Partners
We have been working in close partnership with NHS East of England (now NHS Midlands and East) to improve services based on research results.
This research has now been published, please cite:
Hammond GC, Croudace TJ, Radhakrishnan M, Lafortune L, Watson A, et al. (2012) Comparative Effectiveness of Cognitive Therapies Delivered Face-to-Face or over the Telephone: An Observational Study Using Propensity Methods. PLoS ONE 7(9): e42916.
Download the Fulltext article
For more information regarding this study contact: Dr Louise Lafortune, Cambridge Institute of Public Health, ll394@medschl.cam.ac.uk
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Other useful links
1. BRIEFING PAPER ‘Improving access to psychological therapies‘ discusses this research.
2. CLAHRC BITE summarising the research findings can be downloaded here.
4. The CLAHRC CP study on Improving Access to Psychological Therapies has been published in the January issue of Monitor. To view the article please see the digital edition of Monitor