General practitioner referral of older patients to Improving Access to Psychological Therapies (IAPT): an exploratory qualitative study.

Noel Collins,Laurie Corna

doi:10.1192/bjb.2018.10

Abstract

GP views regarding the treatability of older adults with CBT influenced their willingness to refer to a CBT-based IAPT service. Perceptions of local IAPT assessment processes being distressing and onerous to older patients also motivated referral inaction. GPs expressed a preference to treat depressed older patients themselves (with medication and psychological approaches such as watchful waiting).Clinical implicationsAny strategy to increase referral rates of older adults to CBT-based IAPT services should address local GP concerns regarding assessment processes and the effectiveness of offered treatments.Declaration of interestNone.

Highlights

general practitioner (GP) views regarding the treatability of older adults with cognitive–behavioural therapy (CBT) influenced their willingness to refer to a CBT-based Improving Access to Psychological Therapies (IAPT) service
The GP respondents in this study gave a wide range of clear reasons for their reluctance to refer their older patients to a local IAPT provider offering mostly CBT
These include the belief that older adult depression was an inevitable consequence of ageing and more difficult to treat with CBT

Summary

Results

Participants conceptualised anxiety and depression in later life differently to that which occurs in younger adults. When responding to the needs of depressed older adults, GP participants described a number of approaches that are preferentially used instead of referring to IAPT for CBT. These approaches included addressing physical issues and social needs, prescribing medication and GP-led psychological approaches. These approaches included supportive counselling, exploratory brief therapy and problem solving. Watchful waiting was frequently used as a tried-and-trusted approach to treating elderly people with depression in primary care This intervention, centred on regular review but without active pharmacotherapy or psychotherapy, was felt by participants to be a tangible and containing approach compared with referral to IAPT for CBT:.

Method

Participants

Ethical considerations

Study limitations

Discussion