Poots Alan J, Green Stuart A, Honeybourne Emmi, Green John, Woodcock Thomas, Barnes Ruth, Bell Derek
Address reprint requests to: Alan J. Poots;
Int J Qual Health Care. 2014 Apr;26(2):198-204. doi: 10.1093/intqhc/mzu005. Epub 2014 Feb 11.
To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative.
Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control.
A psychological therapy service in Westminster, London, UK.
People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012.
s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks.
s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator.
Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = -6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories.
QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.
在一项质量改进（QI）举措实现就诊机会增加之后，调查心理治疗服务中患者治疗结果的公平性。
对健康结果进行回顾性服务评估；数据采用方差分析、卡方检验和统计过程控制进行分析。
英国伦敦威斯敏斯特的一项心理治疗服务。
2009年2月至2012年5月期间居住在伦敦威斯敏斯特自治市并接受该服务（通过医疗专业人员转诊或自我转诊）的人群。
采用社会营销干预措施增加转诊，包括通过当地媒体和现有社交网络宣传该服务。
（i）使用患者健康问卷-9（PHQ9）在入组时的抑郁严重程度。（ii）治疗后抑郁严重程度的变化（ΔPHQ9）。（iii）通过关键绩效指标评估的病情实现有意义改善的变化情况。
与来自低贫困地区（M = 13.20，标准差 = 6.75）和中等贫困地区（M = 14.44，标准差 = 6.64）的患者相比，来自高贫困地区的患者入组时抑郁更严重（M = 15.47，标准差 = 6.75）。低、中、高贫困地区的患者在抑郁评分上的变化相似（ΔPHQ9：M = -6.60，标准差 = 6.41）。在整个举措实施阶段和不同贫困类别中，达到关键绩效指标的患者比例相似。
质量改进方法改善了心理健康服务的就诊机会；本文未发现患者临床结局存在差异的证据，无论贫困程度如何，这被解释为就该结局而言该服务不存在不公平的证据。
