The effect of service setting on treatment outcome: A comparison between cognitive behavioural approaches within primary and secondary care

Abstract

Background: Within the National Health Service (NHS) there has been an increasing emphasis on the integration of mental health services within primary care. Research into the effectiveness of cognitive behavioural therapy (CBT) in primary care has produced positive results.Aim: The aim of this study was to compare a hospital-based and a primary care-based CBT service, to investigate if the setting of treatment affected participants' rate of recovery and levels of satisfaction.Method: 52 participants who received CBT treatment for a range of psychological problems in either setting were compared using a non-randomized, quasi-experimental, design. A range of psychological measures were taken at baseline and over the first six treatment sessions, and rate of change in psychological symptoms and satisfaction were compared.Results: Both groups demonstrated improvement over the period of the study but the participants from the primary care group showed a more rapid rate of recovery during the first six sessions, and received briefer treatment. Such differential rates of treatment change were not attributable to group differences in terms of chronicity or severity. The primary care group also reported significantly higher levels of satisfaction.Conclusions: The setting of treatment might impact on patients' outcome, with primary care patients responding more rapidly than those seen in secondary care. Providing a service in primary care might also increase patient compliance with treatment. Further research is needed to investigate longer term outcome, as well as enhancing how well findings can be generalized.Declaration of interest: None.