title: 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.
abstract: BACKGROUND
  UK general practitioners (GPs) refer patients with common mental disorders to community mental health nurses.
  
  
  OBJECTIVE
  To determine the effectiveness and cost-effectiveness of this practice.
  
  
  METHODS
  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%) and 190 (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 higher in both nurse-treated groups. Mean extra costs per patient were 283 pound (95% CI154-411) for generic nurse care, and 315 pound (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.
authors.affiliation: Primary Medical Care Group, Community Clinical Sciences Division, University of Southampton School of Medicine, Aldermoor Health Centre, Southampton SO16 5ST, UK. ark1@soton.ac.uk
authors.forename: T
authors.initials: T
authors.lastname: Kendrick
authors.forename: L
authors.initials: L
authors.lastname: Simons
authors.forename: L
authors.initials: L
authors.lastname: Mynors-Wallis
authors.forename: A
authors.initials: A
authors.lastname: Gray
authors.forename: J
authors.initials: J
authors.lastname: Lathlean
authors.forename: R
authors.initials: R
authors.lastname: Pickering
authors.forename: S
authors.initials: S
authors.lastname: Harris
authors.forename: O
authors.initials: O
authors.lastname: Rivero-Arias
authors.forename: K
authors.initials: K
authors.lastname: Gerard
authors.forename: C
authors.initials: C
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D003156:Community Mental Health Services / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D004739:England; D005194:Family Practice / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000451:nursing; D008875:Middle Aged; D011340:Problem Solving; D011568:Psychiatric Nursing / Q000191:economics* / Q000379:methods; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000191:economics / Q000379:methods; D012017:Referral and Consultation / Q000191:economics; D016896:Treatment Outcome