title: Clinical improvement after treatment provided through the Better Outcomes in Mental Health Care (BOiMHC) programme: do some patients show greater improvement than others?
abstract: OBJECTIVE
  Australia's Better Outcomes in Mental Health Care (BOiMHC) programme enables GPs to refer patients with common mental disorders to allied health professionals for time-limited treatment, through its Access to Allied Psychological Services (ATAPS) projects. This paper considers whether patients who receive care through the ATAPS projects make clinical gains, if so, whether particular patient-related and treatment-related variables are predictive of these outcomes.
  
  
  METHODS
  Divisions of General Practice (Divisions), which run the ATAPS projects, are required to enter de-identified data into a minimum dataset, including data on patients' socio-demographic and clinical characteristics, the sessions of care they receive, and their clinical outcomes. We extracted data from January 2006 to June 2010, and examined the difference between mean pre- and post-treatment scores on the range of outcome measures being used by Divisions. We then conducted a linear regression analysis using scores on the most commonly-used outcome measure as the outcome of interest.
  
  
  RESULTS
  Pre- and post-treatment outcome data were available for 16 700 patients from nine different outcome measures. Across all measures, the mean difference was statistically significant and indicative of clinical improvement. The most commonly-used measure was the Kessler-10 (K-10), and pre- and post-treatment K-10 data were available for 7747 patients. After adjusting for clustering by Division, outcome on the K-10 was associated with age, levels of income and education, previous receipt of mental health care, number of sessions, treatment received and pre-treatment K-10 score. The benchmark was sufficiently high, however, that even the groups that fared relatively less well still showed strong improvement in absolute terms.
  
  
  CONCLUSIONS
  Patients who receive care through the ATAPS projects are making considerable clinical gains. A range of socio-demographic, clinical and treatment-based variables are associated with the levels of outcomes achieved, but improvements are still substantial even for those in the relatively disadvantaged groups.
authors.affiliation: Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria 3010, Australia. j.pirkis@unimelb.edu.au
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.forename: Bridget
authors.initials: B
authors.lastname: Bassilios
authors.forename: Justine
authors.initials: J
authors.lastname: Fletcher
authors.forename: Kristy
authors.initials: K
authors.lastname: Sanderson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.forename: Kylie
authors.initials: K
authors.lastname: King
authors.forename: Fay
authors.initials: F
authors.lastname: Kohn
authors.forename: Philip
authors.initials: P
authors.lastname: Burgess
authors.forename: Grant
authors.initials: G
authors.lastname: Blashki
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods; D015397:Program Evaluation / Q000379:methods; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016896:Treatment Outcome