The British Journal of Psychiatry (2006) 189: 50-59. doi: 10.1192/bjp.bp.105.012435
© 2006 The Royal College of Psychiatrists
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit an eLetter
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Related articles in BJP
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Kendrick, T.
Right arrow Articles by Thompson, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kendrick, T.
Right arrow Articles by Thompson, C.

Cost-effectiveness of referral for generic care or problem-solving treatment from community mental health nurses, compared with usual general practitioner care for common mental disorders

Randomised controlled trial

T. Kendrick, BSc, MD, FRCGP, FRCPsych, L. Simons, RGN, MA and L. Mynors-Wallis, MA, DM, MRCP, MRCPsych

Community Clinical Sciences, University of Southampton School of Medicine

A. Gray, PhD

Health Economics Research Centre, Oxford University

J. Lathlean, MA, DPhil

School of Nursing and Midwifery, University of Southampton

R. Pickering, CStat, PhD and S. Harris, MSc

Community Clinical Sciences, University of Southampton Medical School

O. Rivero-Arias, MSc

Health Economics Research Centre

K. Gerard, MSc, PhD and C. Thompson, MD, FRCP, FRCPsych

Community Clinical Sciences,University of Southampton Medical School, UK

Correspondence: Professor Tony Kendrick, Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Aldermoor Health Centre, Southampton SO16 5ST, UK. Tel: +44(0)23 8024 1050; fax: +44 (0)23 8070 1125; email: ark1{at}soton.ac.uk

Declaration of interest None.

Funded by NHS R&D Programme.

Background UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.

Aims To determine the effectiveness and cost-effectiveness of this practice.

Method Randomised trial with three arms: usual GP care, generic mental health nurse care, and care from nurses trained in problem-solving treatment; 98 GPs in 62 practices referred 247 adult patients with new episodes of anxiety, depression and life difficulties, to 37 nurses.

Results There were 212 (86%) and190 (77%) patients followed up at 8 and 26 weeks respectively. No significant differences between groups were found in effectiveness at either point. Mean differences in Clinical Interview Schedule - Revised scores at 26 weeks compared with GP care were -1.4 (95% CI -5.5 to 2.8) for generic nurse care, and 1.1 (-2.9 to 5.1) for nurse problem-solving. Satisfaction was significantly higherin both nurse-treated groups. Mean extra costs per patient were £283 (95% CI154-411) for generic nurse care, and £315 (183-481) for nurse problem-solving treatment.

Conclusions GPs should not refer unselected patients with common mental disorders to specialist nurses. Problem-solving should be reserved for patients who have not responded to initial GP care.


Related articles in BJP:

Peter Tyrer
BJP 2006 189: 96. [Full Text]  

Highlights of this issue
Sukhwinder S. Shergill
BJP 2006 189: A1. [Full Text]  



This article has been cited by other articles:


Home page
 StrokeHome page
P. H. Mitchell, R. C. Veith, K. J. Becker, A. Buzaitis, K. C. Cain, M. Fruin, D. Tirschwell, and L. Teri
Brief Psychosocial-Behavioral Intervention With Antidepressant Reduces Poststroke Depression Significantly More Than Usual Care With Antidepressant: Living Well With Stroke: Randomized, Controlled Trial
Stroke, September 1, 2009; 40(9): 3073 - 3078.
[Abstract] [Full Text] [PDF]

Home page
 Psychiatr. Serv.Home page
M. van Orden, T. Hoffman, J. Haffmans, P. Spinhoven, and E. Hoencamp
Collaborative Mental Health Care Versus Care as Usual in a Primary Care Setting: A Randomized Controlled Trial
Psychiatr Serv, January 1, 2009; 60(1): 74 - 79.
[Abstract] [Full Text] [PDF]

Home page
 Fam PractHome page
M. Slade, L. Gask, M. Leese, P. McCrone, C. Montana, R. Powell, M. Stewart, and C. Chew-Graham
Failure to improve appropriateness of referrals to adult community mental health services--lessons from a multi-site cluster randomized controlled trial
Fam. Pract., June 1, 2008; 25(3): 181 - 190.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. PsychiatryHome page
P. TYRER

The British Journal of Psychiatry, November 1, 2007; 191(5): 470 - 470.
[Full Text] [PDF]