Piloting a practice research network: a 12-month evaluation of the Human Givens approach in primary care at a general medical practice.
OBJECTIVE
To investigate the effectiveness of the Human Givens (HG) approach to the management of emotional distress in a primary care setting. To investigate whether or not the use of a shorter version (i.e., CORE-10) of a well-established psychometric instrument (i.e., Clinical Outcome in Routine Evaluation (CORE) CORE-outcome measure, CORE-OM) for sessional data collection is feasible for large-scale implementation of a practice research network (PRN).


METHODS
All clients who chose to opt into assessment for treatment with three accredited HG therapists following referral for management of psychological distress, primarily anxiety and depression, by General Medical Practitioners (GPs) or GP practice nurses working in a primary care general medical practice over a 12-month period were included.


METHODS
The primary outcome measures were the CORE-OM and CORE-10. Pre-post effect sizes (Cohen's d) were calculated using pre, post, and pooled standard deviations to facilitate comparison with previously published studies. Mixed-design analysis of variance (ANOVA) was used to look at differences in pre- and post-treatment symptoms and potential treatment effects based on type of termination and gender. Observed intent-to-treat pre-post effect size using the CORE-OM was also benchmarked against data from Clark et al. (2009) improving access to psychological therapies (IAPT) pilot site data. Results obtained using CORE-OM were compared with those obtained using CORE-10 to evaluate the feasibility of using the CORE-10 for routine use in real-world clinical settings.


RESULTS
Pre- to post-treatment changes measured with the CORE-OM and CORE-10 suggested that the therapy was highly effective, with clients remaining in treatment to completion demonstrating the greatest benefit. Reliable change and recovery rates comparisons between the CORE-OM and CORE-10 indicated that the CORE-10 is a viable alternative to the CORE-OM. Result of the benchmarking indicated that the observed pre-post effect size was clinically equivalent to IAPT data published by Clark et al. (2009).


CONCLUSIONS
Although replications are warranted as the current investigation is a pilot study, the HG approach appears to be an effective treatment. CORE-10 is a satisfactory generic sessional assessment to use in place of the 34-item CORE-OM. Use of a shorter yet reliable outcome measure is likely to increase assessment completion rates. PRNs appear to be a suitable mechanism to establish treatment effectiveness across a wide range of treatments in different settings.
Nottingham Trent University, UK. wandrews22@mac.com
William
W
Andrews
Elspeth
E
Twigg
Takuya
T
Minami
Gina
G
Johnson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D019985:Benchmarking; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D010865:Pilot Projects; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D055815:Young Adult