A randomized controlled trial of problem solving for anxiety, depression and life difficulties by community psychiatric nurses among general practice patients: Background and method
Simons L., Mynors-Wallis L., Pickering R., Gray A., Brooking J., Thompson C., Kendrick T.
It is not clear whether treatment for anxiety, depression and life difficulties by community psychiatric nurses in primary care is effective or cost-effective. Community psychiatric nurses are asked to focus their attention on patients with a diagnosis of severe and enduring mental health problems. The one previous study of community psychiatric nurses in primary care found no difference in outcome at 6 months, but patients with community psychiatric nurse care had fewer days off work over the study period. Problem solving by general practitioners (GPs) and community nurses has been shown to be effective for emotional disorders and depression in primary care. Treatment by community psychiatric nurses may have advantages in that it could reduce GP time and prescribing. Patients may prefer community psychiatric nurse care to psychiatric referral and community psychiatric nurses may prefer mixed case loads. This study was designed in order to inform policy on this issue. This paper describes the design of a randomized controlled trial and economic evaluation comparing community psychiatric nurse problem-solving treatment, generic community psychiatric nurse care and usual GP care for patients with anxiety, depression and life difficulties. If referral to community psychiatric nurses proves not to be effective or cost-effective GPs should be advised against referring patients with these types of problems. If community psychiatric nurse intervention is more effective and cost effective than GP treatment then models of care appropriate for delivering in primary care should be considered.