A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care

TLDR

Effectiveness and cost‑benefit of the treatment depend on selecting appropriate patients. The study investigated whether trained community nurses could effectively treat emotional disorders in primary care using problem‑solving therapy. Community nurses were trained in problem‑solving therapy and patients were randomized to receive either nurse‑delivered therapy or usual GP care, with clinical and economic outcomes assessed at baseline, 8 weeks, and 26 weeks. Nurse‑delivered problem‑solving therapy produced no clinical advantage over usual GP care but reduced disability days and work absences, and although it incurred higher health‑care costs, the savings from fewer workdays offset the difference.

Abstract

We set out to investigate whether community nurses could be trained in problem-solving therapy and, once trained, how effective they would be in treating emotional disorders in primary care.Seventy patients with an emotional disorder in primary care were randomly allocated to receive either problem-solving therapy from a trained community nurse or treatment as usual from their general practitioner. Interview and self-rated assessments of clinical and economic outcome were made pretreatment, at eight weeks and at 26 weeks after treatment.There was no difference in clinical outcome between patients who received problem-solving treatment and patients who received the general practitioner's usual treatment. However, patients who received problem-solving treatment had fewer disability days and fewer days off work. The health care cost of problem-solving was greater than that of the general practitioner's usual treatment but this was more than offset by savings in the cost of days off work.Problem-solving treatment can be given by trained community nurses. The clinical effectiveness and cost-benefit of the treatment will depend on the selection of appropriate patients.