ISQUA16-1136IMPROVING ACCESS AND OUTCOMES IN COMMUNITY PSYCHOLOGICAL THERAPIES

Abstract

Objectives: The prevalence of common mental disorders (CMDs), including anxiety and depression, in the general working age population in England is estimated as 16.2%. There are effective treatments for CMDs. In 2007 the UK government announced a large-scale health initiative for improving access to psychological therapies (IAPT). NIHR Collaboration for Leadership in Applied Health Research and Care Northwest London worked with an IAPT service, using quality improvement (QI) methods and media campaigns to increase referrals from areas of deprivation, and asks whether the service, supported by improvement science, provided quality care. Methods: Geospatial and temporal analyses (ANOVA and Statistical Process Control) of observational data taken during normal provision of care assessed the impact on improving access to the service and assess outcome, by Patient Health Questionnaire (PHQ)-9 score [1,2]. Broadening the dataset to an additional service, discriminant analysis was conducted to identify patient and treatment factors predictive of clinical outcomes [3]. Current work uses the largest naturalistic mental health intervention dataset worldwide?, a systematic literature review and statistical modelling to establish a new recovery metric and predict improvement. Results: Average weekly referrals rose from 17 to 43 during the QI phase. Geospatial analysis demonstrated that people from areas of high deprivation had increased referral during and following the QI interventions [1]. Outcome analysis showed that patients from areas of high deprivation entered the service with more severe depression (PHQ-9: M= 15.47, SD = 6.75) compared to patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation [2]. Improvements in the depression score (ΔPHQ9) showed no evidence of difference regardless of socio-economic status (M = -6.60, SD = 6.41) [2]. Predictive models assigned a positive or negative clinical outcome to each patient, with accuracy 69.4% and 79.3% respectively, using five independent pre-treatment variables: initial severity of anxiety and depression, ethnicity, deprivation and gender [3]. The numbers of sessions attended or missed were also important factors [3]. Conclusion: This abstract discusses the effect of a QI initiative on access and outcome for community mental health. The results demonstrate improved access to mental health services for those from deprived areas, and found no evidence of clinical outcome differences. Identifying factors such as severity of CMD and ethnicity allows practitioners to modify delivery of services to better meet population needs, and in turn may improve outcomes. Despite demographic and service delivery differences, all services measure their success using a strict metric for 'caseness' (whether a PHQ9 score exceeds a threshold value) as indicative of a 'recovery rate'; this does not control for the severity of the individual case at the point of referral. We argue that using a measure that accounts for baseline severity at point of referral provide a fairer measure. Anxiety and depression are linked to social deprivation and improving those, also improves the deprivation scores.