Helping Urgent Care Users Cope with Distress about Physical Complaints
Research type
Research Study
Full title
Helping Urgent Care Users Cope with Distress about Physical Complaints: A Randomised Controlled Trial
IRAS ID
150153
Contact name
Richard Morriss
Contact email
Sponsor organisation
Head of Research and Graduate Services
Duration of Study in the UK
3 years, 5 months, 17 days
Research summary
Helping Urgent Care Users Cope with Distress about Physical Complaints
Background
Medically Unexplained Symptoms (MUS) may cost the National Health Service (NHS) £3 billion per year in unnecessary expenditure, much of it on unscheduled/urgent care and in-patient admission. Clinical Commissioning Groups are incentivised to reduce emergency care use and the Department of Health is spending up to an additional £400 million per year to provide psychological treatment. However, face to face delivery of this intervention through secondary care mental health and Improving Access to Psychological Therapies(IAPT) services has not been acceptable to these service users. Remotely delivered psychological treatment (therapy delivered via video calling systems similar to Skype or over the telephone)may be both more acceptable to service users than face to face treatment in IAPT services and may be just as effective as in secondary acute care.
Aims
We wish to determine the clinical and cost effectiveness of remotely delivered cognitive behaviour therapy for health anxiety in repeated users of unscheduled/urgent primary or secondary care for physical symptoms without an underlying physical health cause. We also want to determine what aspects might facilitate and hinder the delivery of remote CBT and how such treatment might fit into a wider care pathway to enhance patient experience of care.
Methods of research
Randomised controlled trial(RCT) of 6-10 sessions of cognitive behaviour therapy for health anxiety delivered by telephone or through video calling versus treatment as usual. Over a period of 12 months we will assess change in health anxiety, health care use, generalised anxiety, depression, somatic distress, work and social adjustment and quality of life for both groups. We will also carry out qualitative interviews with some service users and staff who are involved in the management and delivery of unscheduled/urgent care to determine what aspects facilitate and hinder the delivery of the intervention.Summary of results
Why we did the study
Health anxiety is persistent worry about health and can have a severe detrimental and debilitating impact on overall health. It can lead to increased visits to accident and emergency departments, walk in centres or urgent same day appointments at the GP surgery with little patient benefit. Despite some availability of effective treatment for health anxiety, few people take it up. Psychological therapy delivered remotely (via the internet or over the telephone) has been found to help patients where anxiety or stigma may cause reluctance to access mental health services face-to-face. Remotely delivered psychological therapy has equivalent rates of recovery and patient satisfaction to face-to-face delivery. Given the accessibility and cost benefits, remotely delivered therapy may be a suitable delivery option.
What we did
We wanted to help people who often use unscheduled care to manage the distress caused by worries about their health. In particular we wanted to find out whether Cognitive Behavioural Therapy (CBT), a type of talking therapy, delivered remotely (via video calling or over the telephone), could improve physical and emotional health and reduce health care service use. CBT explores how thoughts, feelings, bodily sensations and actions affect each other and how these can be changed to help manage difficulties. We aimed to find out if remotely delivered CBT is clinically and cost effective compared to usual care. We will also wanted to find the best way of delivering this treatment by talking with service users, health professionals, other experts and researchers.
What we found
We found that those who received the CBT reported greater reductions in health anxiety, overall anxiety and depressive symptoms. They also reported an overall
Potential benefits of the study
The findings could lead to improved healthcare and inform government policy on the development of services which are more effective and targeted towards individual needs.REC name
London - Riverside Research Ethics Committee
REC reference
14/LO/1102
Date of REC Opinion
25 Jul 2014
REC opinion
Further Information Favourable Opinion