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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

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.

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