title: Developing Services for Patients with Depression or Anxiety in the Context of Long-term Physical Health Conditions and Medically Unexplained Symptoms: Evaluation of an IAPT Pathfinder Site.
abstract: BACKGROUND
  There are national policy drivers for mental health services to demonstrate that they are effectively meeting the psychological needs of people with long-term health conditions/medically unexplained symptoms (LTC/MUS).
  
  
  OBJECTIVE
  To evaluate the implementation of a stepped-care service delivery model within an Improving Access to Psychological Therapies (IAPT) service for patients with depression or anxiety in the context of their LTC/MUS.
  
  
  METHODS
  A stepped-care model was designed and implemented. Clinical and organizational impacts were evaluated via analyses of LTC/MUS patient profiles, throughputs and outcomes.
  
  
  RESULTS
  The IAPT service treated N = 844 LTC and N = 172 MUS patients, with the majority (81.81%) receiving a low intensity intervention. Dropout across the service steps was low. There were few differences between LTC and MUS outcome rates regardless of step of service, but outcomes were suppressed when compared to generic IAPT patients.
  
  
  CONCLUSIONS
  The potential contribution of IAPT stepped-care service delivery models in meeting the psychological needs of LTC/MUS patients is debated.
authors.affiliation: University of Sheffield and Sheffield Health and Social Care Foundation NHS Trust,UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kellett
authors.affiliation: University of Sheffield,UK.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Webb
authors.affiliation: Psychological Services,Sheffield Health and Social Care NHS Foundation Trust,UK.
authors.forename: Nic
authors.initials: N
authors.lastname: Wilkinson
authors.affiliation: Sheffield Improving Access to Psychological Therapies Service,UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bliss
authors.affiliation: Sheffield Improving Access to Psychological Therapies Service,UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Ayers
authors.affiliation: University of Sheffield,UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Hardy
mesh_terms: D000328:Adult; D001007:Anxiety / Q000150:complications / Q000628:therapy; D001008:Anxiety Disorders / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000628:therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D000071896:Medically Unexplained Symptoms; D008605:Mental Health Services; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012189:Retrospective Studies
keywords: IAPT; LTC; MUS; stepped-care