Harvey I, Nelson S J, Lyons R A, Unwin C, Monaghan S, Peters T J
Department of Social Medicine, University of Bristol.
Br J Gen Pract. 1998 Mar;48(428):1043-8.
Counselling in primary care settings remains largely unevaluated. Such evaluation has been strongly recommended.
To determine the relative effectiveness and cost-effectiveness of generic counselling and usual general practitioner (GP) care for patients with minor mental health problems.
A randomized controlled trial and health economic evaluation were carried out in nine general practices. Access to generic counselling (brief counselling, generally involving up to six 50-minute sessions) was compared with usual GP care. A total of 162 patients aged 16 years and over with diverse mental health problems (excluding phobic conditions and psychoses) were randomized. The Hospital Anxiety and Depression (HAD) scale, COOP/WONCA (World Organization of Family Doctors) functional health assessment charts, and the delighted-terrible faces scale were used to assess outcome four months after randomization.
The two groups were similar at baseline. There were significant improvements in both groups between randomization and follow-up for most outcome measures, but no significant differences between the study arms. The 95% confidence limits were narrow and excluded clinically significant effects. Under various assumptions concerning the cost of secondary care referrals and of counselling time, no clear cost advantage was associated with either intervention.
This pragmatic trial demonstrates no difference in functional or mental health outcome at four months between subjects offered access to counselling and those given usual care by their GP. There is no clear difference in the cost-effectiveness of the two interventions. Purchasers should take account of these findings in allocating resources within primary care.
基层医疗环境中的咨询服务在很大程度上仍未得到评估。强烈建议进行此类评估。
确定针对轻度心理健康问题患者的一般咨询服务与普通全科医生常规诊疗的相对有效性和成本效益。
在9家全科诊所开展了一项随机对照试验和卫生经济评估。将获得一般咨询服务（简短咨询，通常包括最多6次每次50分钟的咨询）与普通全科医生常规诊疗进行比较。共162名16岁及以上患有各种心理健康问题（不包括恐惧症和精神病）的患者被随机分组。使用医院焦虑抑郁量表（HAD量表）、COOP/WONCA（世界家庭医生组织）功能健康评估图表以及高兴-难过面部表情量表在随机分组4个月后评估结果。
两组在基线时相似。对于大多数结果指标，随机分组和随访之间两组均有显著改善，但研究组之间无显著差异。95%置信区间较窄，排除了具有临床意义的效应。在关于二级医疗转诊成本和咨询时间的各种假设下，两种干预措施均未显示出明显的成本优势。
这项务实的试验表明，在4个月时，获得咨询服务的受试者与接受全科医生常规诊疗的受试者在功能或心理健康结果方面没有差异。两种干预措施在成本效益方面没有明显差异。购买者在基层医疗资源分配中应考虑这些结果。
