A description and evaluation of the introduction of a primary care clinical psychology service in one health district

Abstract

The introduction of a primary care clinical psychology service into one Scottish Health District is described and evaluated. The service was widely used by G.P.s, and the volume of referrals increased each year. After 5 years of operation 83% of G.P.s had referred cases. The types of problems referred are described, two thirds of patients were suffering from generalised anxiety or phobias. The patients were a chronic population, the average length of problem being 6.9 years. G.P. and psychiatrist referred patients were compared, the latter had longer histories and there were differences in the types of problem referred. Outcome was evaluated using a number of measures. Consultation rate fell significantly post treatment and a significant proportion of patients stopped psychotropic medication. There were significant reductions in psychologist ratings of severity and in handicap, and in patient self-ratings of severity and General Health Questionnaire scores. Patient satisfaction with treatment 6 months post discharge was surveyed. The G.P.s satisfaction with the service was surveyed and found to be high. At follow up G.P.s rated 69% of patients as receiving "definite benefit" and 31% as "unchanged". A study of treatment of the commonest problem referred, generalised anxiety, was conducted using a waiting-list control group. Treatment group patients improved significantly on self rating questionnaires, controls did not change, but showed a similar order of treatment response when they did enter treatment. The costs of the service are compared to another report in the literature, and it is concluded that the service was cost-effective. A number of recommendations are made for further research in the field. It is concluded that primary care psychology services are feasible in terms of staffing levels, and also lead to significant patient benefit.