Enhancing recovery rates: lessons from year one of IAPT

Alex Gyani, Roz Shafran, Richard Layard, David M Clark, Alex Gyani, Roz Shafran, Richard Layard, David M Clark

Abstract

Background: The English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.

Method: Data from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).

Results: Data completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.

Conclusions: Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.

Keywords: Anxiety disorders; CBT; Depression; Dissemination; IAPT; NICE; Outcome monitoring; Psychological therapies.

Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Cohort used in the analyses.
Fig. 2
Fig. 2
Variability in service reliable recovery rates.
Fig. 3
Fig. 3
Change in PHQ-9 scores as a function of initial severity.
Fig. 4
Fig. 4
Comparison of Reliable Recovery Rates between patients who received guided and pure self-help by diagnosis among patients whose last scores on the PHQ-9 and GAD-7 scores are carried forward.

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Source: PubMed

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