title: Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: controlled before and after study.
abstract: BACKGROUND
  Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known.
  
  
  METHODS
  Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121,199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence.
  
  
  RESULTS
  Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference -0.21, p = 0.003).
  
  
  CONCLUSIONS
  Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance.
authors: Department of Health Care Management and Policy, University of Surrey, Guildford GU2 7XH, UK. s.Lusignan@surrey.ac.uk
authors: Simon
authors: S
authors: de Lusignan
authors: Tom
authors: T
authors: Chan
authors: Maria C
authors: MC
authors: Tejerina Arreal
authors: Glenys
authors: G
authors: Parry
authors: Kim
authors: K
authors: Dent-Brown
authors: Tony
authors: T
authors: Kendrick
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002908:Chronic Disease / Q000523:psychology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000188:drug therapy* / Q000523:psychology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy; D012017:Referral and Consultation
chemical_list: D000928:Antidepressive Agents
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