School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Behav Res Ther. 2013 Sep;51(9):597-606. doi: 10.1016/j.brat.2013.06.004. Epub 2013 Jul 4.
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.
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).
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.
Compliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.
英国改善心理治疗机会（IAPT）计划旨在使基于证据的抑郁症和焦虑症心理治疗在国民保健制度（NHS）中更广泛地应用。该计划的第一年设立了 32 个基于阶梯式护理模式的 IAPT 服务。我们报告了在这些服务中接受治疗的患者所取得的可靠康复率，并确定了患者水平、服务水平以及遵守国家卫生与保健卓越研究所（NICE）治疗指南的功能的预测因素。
分析了在治疗期间接受过至少两次治疗、至少有两次治疗结果评分且完成治疗的 19395 名临床患者的数据。使用患者健康问卷抑郁量表（PHQ-9）和焦虑量表（GAD-7）评估治疗结果。
对于常规队列研究来说，数据完整性很高。超过 91%的接受治疗的患者有配对（治疗前后）的结果评分。总体而言，40.3%的患者在治疗后可靠地康复，63.7%的患者显示可靠的改善，6.6%的患者显示可靠的恶化。大多数患者接受了 NICE 推荐的治疗。当提供了不被 NICE 推荐的治疗时，康复率会降低。预测更高可靠康复率的服务特征包括：平均治疗次数多；接受低强度治疗的个体升级率高；服务规模大；经验丰富的员工比例高。
遵守 IAPT 临床模式与提高可靠康复率有关。
