What factors are associated with improvement after brief psychological interventions in primary care? Issues arising from using routine outcome measurement to inform clinical practice

Abstract

Study purpose: This descriptive study used a routine practice dataset to investigate whether demographic variables and intervention length were associated with outcome after brief psychological interventions in primary care. Brief description of the participants: The data are from 3687 adults with a wide range of presenting problems, from a culturally diverse inner London borough, referred to primary care psychologists and counsellors. Methodology: Demographic and service activity data were routinely collected using a local monitoring form and self-report outcome data using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The paradigm of reliable and clinically significant change was used to explore individual as well as group change. The relationship between demographic variables, intervention length and outcome was investigated. Results, conclusions and implications: Sixty-six per cent of the group with complete outcome data (n 0/458) showed reliable improvement and 45% also showed clinically significant improvement after the intervention. Ethnicity was not related to outcome, suggesting that the service was not culturally biased in this respect (although clients from ethnic minorities were significantly underrepresented in the sample of clients who attended). Women and employed clients were more likely to show improvement. Unemployed men had comparatively poor outcomes. There was a positive relationship between length of intervention and improvement. As is often the case, client and data attrition were high: the small sample for which complete outcome data were available reduced the representativeness and generalisability of the findings which must therefore be treated with caution. Issues of attrition must be addressed in future to ensure that data quality is sufficient to increase confidence in using it for service management, development and 'benchmarking'. However, the study adds to the growing body of 'practice-based evidence' supporting the provision of primary care psychology and counselling services. The findings suggest that the employment status and gender of clients may both need to be considered when 'benchmarking' outcomes.

Who drops‐out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

“…This study indicates the benefits of using routinely collected large datasets to address research questions of interest to counsellors and psychotherapists (Mellor-Clark et al, 2001;Shepherd et al, 2006). The analysis of routine data in terms of individual characteristics and covariates can increase understanding regarding those clients that are more likely to drop-out of therapy.…”

“…The short‐term efficacy of counselling has been well documented (Bower and Rowland, ), and its effectiveness in NHS Primary Care practice has been supported by studies of large routinely collected datasets (Mellor‐Clark, Connell, & Barkham, ; Shepherd, Ashworth, Evans, Robinson, Rendall, & Ward, ). These datasets also indicate a proportion of clients having a level of psychological distress similar to clients treated in secondary care (Barkham, Gilbert, Connell, Marshall, & Twigg, ), even though the application of counselling to more severe conditions such as severe depression has not been supported by National Institute for Health and Clinical Excellence (NICE) guidelines (NICE, ).…”

“…The Department of Health has identified the need for the collection of routine data, including outcome measures, to audit, evaluate and monitor services in order to improve them (DoH, ). This study utilises such data for research purposes in line with the growing recognition that evidence from controlled trials of psychological therapies needs to be supplemented by evidence from observational data collected in routine practice (Mellor‐Clark et al, ; Shepherd et al, ).…”

Age, Gender, and Ethnicity Effects on Parent–Child Discrepancy Using Identical Item Measures

“…Furthermore, although efforts have been made to improve multicultural awareness in clinicians, the trend of minority under-utilization and premature termination continues to be reported (e.g., Austin and Wagner 2006;Diaz et al 2005;King and Canada 2004;Shepherd et al 2005;Staudt 2003). The current findings would suggest that discussion and evaluation of reporter differences may provide one more avenue of intervention designed to make psychological services more available to minority members.…”

Validation of the Italian version of the clinical outcomes in routine evaluation outcome measure (CORE‐OM)

“…The Clinical Outcomes in Routine EvaluationOutcome Measure (CORE-OM; Evans et al, 2000) is a 34-item self-report measure, which is widely used in the UK and shown to be reliable, valid and acceptable in a range of settings (Barkham et al, 2002;Evans, Connell, Barkham, Marshall, & Mellor-Clark, 2003;Shepherd et al, 2005). The items cover four domains: subjective well-being, problems/symptoms, life functioning and risk.…”