TY - JOUR
T1 - The impact of mental health support for the chronically ill on hospital utilisation
T2 - evidence from the UK
AU - Gruber, Jonathan
AU - Lordan, Grace
AU - Pilling, Stephen
AU - Propper, Carol
AU - Saunders, Rob
N1 - Funding Information:
Our findings suggest that the receipt of psychological treatment is associated with a reduction in hospital utilisation, supporting previous findings (Chiles, 1999; Park et al., 2013; Toffolutti et al., 2021). Larger effects are observed 12-months after the end of treatment but we show significant decreases also immediately after (0 months) and 6 months after the end of IAPT for diabetes and CVD. These positive effects may be linked to an improvement in mental health and the ability to better care for the LTC (Chiles, 1999). Given around 25% of patients using IAPT services self-report an LTC (NHS Digital, 2017; NHS Digital, 2016) our findings suggest that the benefits of IAPT treatment may stretch further than positive ?recovery? rates and spillover into reduced use of physical healthcare. Our findings provide support for the potential for interventions targeted at patients who have both CMDs and long term physical conditions, specifically COPD, Diabetes and CVD, to reduce healthcare utilisation (Chiles, 1999; Park et al., 2013; Tsiachristas et al., 2016). In the UK context they support the recently developed Integrated-IAPT programme which extends IAPT to individuals with co-occurring mental and physical health issues (NHS England, 2018b). A recently published analysis of three sites involved in the Integrated-IAPT programme have demonstrated secondary care hospital utilisation cost savings (Toffolutti et al., 2021). Our current findings provide a national picture and support the potential role of the Integrated-LTC programme to reduce hospital utilisation.We acknowledge NHS England funding of this work. We are grateful for comments received from the NHS England Steering group for this work. We also thank Dr Joshua E.J. Buckman for comments on a previous version of this manuscript. Data management (and analytical support) was provided by the Big Data and Analytical Unit (BDAU) at the Institute of Global Health Innovation (IGHI), Imperial College London, UK. Stephen Pilling was supported by the National Institute for Health Research University College London Hospital's Biomedical Research Centre, UK.
Funding Information:
This work was funded by the NHS England. The authors have no further competing interests to declare.
Funding Information:
NHS England funded this research. The funding agreement stipulated that the funder had the right to comment but final decisions, including the content for publication, resided with the authors. NHS England had no role in study design, data collection or interpretation. It commented on the initial report and asked for additional robustness to support the primary results. The primary results did not change and are the focus of this study.
Publisher Copyright:
© 2022 Elsevier Ltd
PY - 2022/2
Y1 - 2022/2
N2 - Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.
AB - Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency Room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n = 816), Diabetes (n = 2813) or Cardiovascular Disease (CVD) (n = 4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up to March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring CMDs and long-term chronic conditions.
KW - Anxiety
KW - Chronic conditions
KW - Depression
KW - Hospital utilisation
KW - Psychological interventions
UR - http://www.scopus.com/inward/record.url?scp=85122620896&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2021.114675
DO - 10.1016/j.socscimed.2021.114675
M3 - Article
C2 - 35032745
AN - SCOPUS:85122620896
SN - 0277-9536
VL - 294
JO - Social Science & Medicine
JF - Social Science & Medicine
M1 - 114675
ER -
