730 Trial Of Problem Solving By Community Psychiatric Nurses (Cpns) For Anxiety, Depression And Life Difficulties Among General Practice Patients (The Cpn-Gp Study)

Author(s): 
Kendrick, Tony, University of Southampton, UK; Simons, Lucy; Thompson, Chris; Mynors-Wallis, Laurence; Lathlean, Judith; Pickering, Ruth; Gerard, Karen.
Text: 
Context: Given direct access to (secondary care) CPNs, UK GPs refer them patients with anxiety, depression and reactions to life difficulties, but it has not been established that CPN referral is cost-effective for these problems, which are often self-limiting.
Objectives:
To compare the cost-effectiveness of CPN generic support, specific CPN problem-solving therapy, and usual GP care.
Design: An RCT with three arms: CPN problem-solving, generic CPN care, and usual care.
Patients: Practice attenders with at least four weeks of anxiety, depression or reactions to life difficulties.
Outcome measures: Patients were assessed at baseline, 8 weeks and 26 weeks, for symptoms on the CIS-R, problem severity, social functioning, quality of life, health service utilisation, and disability days.
Results: CPNs were recruited from four mental health trusts, and 20 were trained in problem-solving, with another 20 treating patients with non-specific support. A total of 75 practices were recruited, and 245 patients were randomised to the three arms of the study. The large majority of patients recover by the 8 week follow-up. There were no significant differences found between the three arms at 8 weeks or 26 weeks in symptoms, social functioning, or quality of life. Cost data are currently being analysed and will be presented in March 2004.
Conclusions:
Specialised mental health nurse support is no better than support from the family practitioner for patients with milder forms of anxiety, depression, and life difficulties. Such support should be reserved for severe and enduring mental illness.
Literature: 
730 TRIAL OF PROBLEM SOLVING BY COMMUNITY PSYCHIATRIC NURSES (CPNS) FOR ANXIETY, DEPRESSION AND LIFE DIFFICULTIES AMONG GENERAL PRACTICE PATIENTS (THE CPN-GP STUDY)