Centre for Health Policy, Programs and Economics, Melbourne School of Population Health, University of Melbourne, Melbourne, Victoria 3010, Australia.
Aust N Z J Psychiatry. 2011 Apr;45(4):289-98. doi: 10.3109/00048674.2010.539195. Epub 2010 Dec 13.
Australia's Better Outcomes in Mental Health Care (BOiMHC) programme enables GPs to refer patients with common mental disorders to allied health professionals for time-limited treatment, through its Access to Allied Psychological Services (ATAPS) projects. This paper considers whether patients who receive care through the ATAPS projects make clinical gains, if so, whether particular patient-related and treatment-related variables are predictive of these outcomes.
Divisions of General Practice (Divisions), which run the ATAPS projects, are required to enter de-identified data into a minimum dataset, including data on patients' socio-demographic and clinical characteristics, the sessions of care they receive, and their clinical outcomes. We extracted data from January 2006 to June 2010, and examined the difference between mean pre- and post-treatment scores on the range of outcome measures being used by Divisions. We then conducted a linear regression analysis using scores on the most commonly-used outcome measure as the outcome of interest.
Pre- and post-treatment outcome data were available for 16 700 patients from nine different outcome measures. Across all measures, the mean difference was statistically significant and indicative of clinical improvement. The most commonly-used measure was the Kessler-10 (K-10), and pre- and post-treatment K-10 data were available for 7747 patients. After adjusting for clustering by Division, outcome on the K-10 was associated with age, levels of income and education, previous receipt of mental health care, number of sessions, treatment received and pre-treatment K-10 score. The benchmark was sufficiently high, however, that even the groups that fared relatively less well still showed strong improvement in absolute terms.
Patients who receive care through the ATAPS projects are making considerable clinical gains. A range of socio-demographic, clinical and treatment-based variables are associated with the levels of outcomes achieved, but improvements are still substantial even for those in the relatively disadvantaged groups.
澳大利亚的改善精神卫生保健成果（BOiMHC）计划通过其获取心理治疗服务（ATAPS）项目使全科医生能够将患有常见精神障碍的患者转介给联合健康专业人员进行限时治疗。本文考虑了通过 ATAPS 项目接受治疗的患者是否获得了临床收益，如果有，哪些特定的患者相关和治疗相关变量可以预测这些结果。
开展 ATAPS 项目的普通科医生分部（Divisions）需要将去识别数据输入到最小数据集，包括患者的社会人口统计学和临床特征、接受的治疗次数以及临床结果的数据。我们从 2006 年 1 月至 2010 年 6 月提取数据，并检查了不同的治疗结果衡量标准中患者治疗前后得分的差异。然后，我们使用最常用的结果衡量标准的得分作为感兴趣的结果进行线性回归分析。
从九个不同的结果衡量标准中获得了来自九个不同分部的 16700 名患者的治疗前后的结果数据。在所有的衡量标准中，差异的平均值具有统计学意义，表明了临床改善。最常用的衡量标准是 Kessler-10（K-10），对 7747 名患者进行了治疗前后的 K-10 数据采集。在调整分部聚类后，K-10 的结果与年龄、收入和教育水平、之前接受的心理健康护理、治疗次数、治疗类型和治疗前的 K-10 得分有关。然而，基准值已经足够高，即使是那些表现相对较差的群体，其绝对水平的改善仍然非常显著。
通过 ATAPS 项目接受治疗的患者正在取得可观的临床收益。一系列社会人口统计学、临床和治疗相关的变量与所取得的结果水平有关，但即使是那些处于相对劣势的群体，其治疗效果仍有显著提高。
