Abstract
ObjectiveTo investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative.DesignRetrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control.SettingA psychological therapy service in Westminster, London, UK.ParticipantsPeople living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012.Intervention(s)Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks.Main Outcome Measure(s)(i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator.ResultsPatients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories.ConclusionsQI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.
Highlights
In the UK, the Department of Health explicitly includes policy to reduce health inequalities within the National Health Service (NHS)
quality improvement (QI) methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome
The Improving Access to Psychological Therapies (IAPT) programme is based on evidence-based recommendations from the National Institute of Health and Clinical Excellence, proposing cognitive behavioural therapy should be available for a range of common mental disorders (CMDs), including anxiety and depression [3,4,5,6,7]
Summary
Over the last 30 years much of the policy focus has been on the wider determinants of health but more recent efforts have included improving access to services [1]. National policy recognizes inequities in access lead to poorer clinical outcomes and exacerbate health inequalities; improving equal access on the basis of need should be a priority [2]. Improving access to mental health services is an example where national policy has been developed to address inequities. The Improving Access to Psychological Therapies (IAPT) programme is based on evidence-based recommendations from the National Institute of Health and Clinical Excellence, proposing cognitive behavioural therapy (and additional specific therapies) should be available for a range of common mental disorders (CMDs), including anxiety and depression [3,4,5,6,7]. The IAPT programme aims to improve access to treatment by providing an accessible community-based service that improves clinical outcomes for patients, delivering a more equitable service [8]
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