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Developing and evaluating psychological provision in the acute hospital setting for patients with chronic respiratory disease

Published online by Cambridge University Press:  01 August 2017

Graham R Thew ,
Jackie MacCallam ,
Paul M Salkovskis  and
Jay Suntharalingam
Graham R Thew*
Affiliation:
Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
Jackie MacCallam
Affiliation:
Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
Paul M Salkovskis
Affiliation:
Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
Jay Suntharalingam
Affiliation:
Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
*
*Author for correspondence: Graham Thew; present address: Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, Oxford OX1 1TW, UK. E-mail: graham.thew@psy.ox.ac.uk
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Abstract

Physical health outcomes for patients with long-term conditions can be significantly affected by their psychological wellbeing; those experiencing psychological difficulties are less able to manage symptoms, have a poorer quality of life, and more frequent hospital admissions. National guidance recommends the assessment and treatment of psychological difficulties secondary to respiratory disease, but implementation of this across services is inconsistent. Here, we describe the process and findings of a 9-month study integrating psychological assessment and intervention into an acute respiratory department. The aim of this provision was to provide appropriate interventions for both in-patients and out-patients with identified psychological needs, and to evaluate the impact of these across a range of outcome domains. Psychological assessment and intervention was flexibly implemented as clinically appropriate within the context of the wider multidisciplinary team. Hospital admissions data were collated, and feedback obtained from both patients and staff. Results highlighted that psychological provision was well received by both patients and staff, and was associated with improved patient experiences and a greater focus on holistic care. Of the 73 patients receiving psychology input with at least 1 month of follow-up data, 75% showed a reduction in their admission frequency following intervention. The estimated savings to the wider NHS exceeded the costs of providing psychology input. In light of existing literature, national guidance, and the present findings, we highlight the need for those commissioning and managing respiratory services to consider the various potential benefits of integrating psychological provision for a patient group with high levels of psychological need.

Keywords

respiratoryservice developmentservice evaluationhospital admissionslong-term conditions
Type
Service models and forms of delivery
Information
the Cognitive Behaviour Therapist , Volume 10 , 2017 , e5
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Atlantis, E, Fahey, P, Cochrane, B, Smith, S (2013). Bidirectional associations between clinically relevant depression or anxiety and COPD: a systematic review and meta-analysis. Chest 144, 766–777.Google Scholar
Bolton, CE, Bevan-Smith, EF, Blakey, JD, Crowe, P, Elkin, SL, Garrod, R (2013). British Thoracic Society guideline on pulmonary rehabilitation in adults: Accredited by NICE. Thorax 68 (suppl 2), ii1–ii30.Google Scholar
Cao, Z, Ong, KC, Eng, P, Tan, WC, Ng, TP (2006). Frequent hospital readmissions for acute exacerbation of COPD and their associated factors. Respirology 11, 188–195.CrossRefGoogle ScholarPubMed
Chiles, JA, Lambert, MJ, Hatch, AL (1999). The impact of psychological interventions on medical cost offset: a meta-analytic review. Clinical Psychology: Science and Practice 6, 204–220.Google Scholar
Coventry, PA, Gemmell, I, Todd, CJ (2011). Psychosocial risk factors for hospital readmission in COPD patients on early discharge services: a cohort study. BMC Pulmonary Medicine 11, 49.Google Scholar
Department of Health (2011). No health without mental health: a cross-government strategy for people of all ages. Available at: https://www.gov.uk/government/publications/the-mental-health-strategy-for-england.Google Scholar
Dowson, C, Kuijer, R, Mulder, R (2004). Anxiety and self-management behaviour in chronic obstructive pulmonary disease: what has been learned? Chronic Respiratory Disease 1, 213–220.CrossRefGoogle ScholarPubMed
Felker, B, Bush, KR, Harel, O, Shofer, JB, Shores, MM, Au, DH (2010). Added burden of mental disorders on health status among patients with chronic obstructive pulmonary disease. Primary Care Companion to the Journal of Clinical Psychiatry 12, e1–e8.Google Scholar
Goodman, H, Firouzi, A, Banya, W, Lau-Walker, M, Cowie, MR (2013). Illness perception, self-care behaviour and quality of life of heart failure patients: a longitudinal questionnaire survey. International Journal of Nursing Studies 50, 945–953.Google Scholar
Gudmundsson, G, Gislason, T, Janson, C, Lindberg, E, Hallin, R, Ulrik, CS (2005). Risk factors for rehospitalisation in COPD: role of health status, anxiety and depression. European Respiratory Journal 26, 414–419.Google Scholar
Hallas, C, Howard, C, Theadom, A, Wray, J (2012). Negative beliefs about breathlessness increases panic for patients with chronic respiratory disease. Psychology, Health and Medicine 17, 467–477.CrossRefGoogle ScholarPubMed
Hallas, C, Howard, C, Wray, J (2009). Understanding panic disorder in chronic respiratory disease. British Journal of Nursing 18, 527–529.CrossRefGoogle ScholarPubMed
Howard, C, Dupont, S (2014). ‘The COPD breathlessness manual’: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. NPJ Primary Care Respiratory Medicine 24, 14076.Google Scholar
Howard, C, Dupont, S, Haselden, B, Lynch, J, Wills, P (2010). The effectiveness of a group cognitive-behavioural breathlessness intervention on health status, mood and hospital admissions in elderly patients with chronic obstructive pulmonary disease. Psychology, Health and Medicine 15, 371–385.Google Scholar
Hutter, N, Schnurr, A, Baumeister, H (2010). Healthcare costs in patients with diabetes mellitus and comorbid mental disorders – a systematic review. Diabetologia 53, 2470–2479.Google Scholar
Katon, WJ (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry 54, 216–226.Google Scholar
Kitagawa, R, Yasui-Furukori, N, Tsushima, T, Kaneko, S, Fukuda, I (2011). Depression increases the length of hospitalization for patients undergoing thoracic surgery: a preliminary study. Psychosomatics 52, 428–432.Google Scholar
Kunik, ME, Roundy, K, Veazey, C, Souchek, J, Richardson, P, Wray, NP (2005). Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest Journal 127, 1205–1211.Google ScholarPubMed
Layard, R, Clark, DM (2014). Thrive: The Power of Evidence-Based Psychological Therapies. London: Penguin UK.Google Scholar
Livermore, N, Sharpe, L, McKenzie, D (2010). Prevention of panic attacks and panic disorder in COPD. European Respiratory Journal 35, 557–563.Google Scholar
Mikkelsen, RL, Middelboe, T, Pisinger, C, Stage, KB (2004). Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD): a review. Nordic Journal of Psychiatry 58, 65–70.Google Scholar
National Institute for Health and Care Excellence (NICE) (2009). Depression in adults with a chronic physical health problem. Clinical Guideline 91. Available at: https://www.nice.org.uk/guidance/cg91 Google Scholar
National Institute for Health and Care Excellence (NICE) (2010). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Clinical Guideline 101. Available at: https://www.nice.org.uk/guidance/cg101 Google Scholar
National Institute for Health and Care Excellence (NICE) (2011). Lung cancer. Clinical Guideline 121. Available at: https://www.nice.org.uk/guidance/cg121 Google Scholar
National Institute for Health and Care Excellence (NICE) (2013). Idiopathic pulmonary fibrosis. Clinical Guideline 163. Available at: https://www.nice.org.uk/guidance/cg163 Google Scholar
Naylor, C, Parsonage, M, McDaid, D, Knapp, M, Fossey, M, Galea, A (2012). Long-term Conditions and Mental Health: The Cost of Co-morbidities. London: The King's Fund and Centre for Mental Health.Google Scholar
Pasteur, MC, Bilton, D, Hill, AT (2010). British Thoracic Society guideline for non-CF bronchiectasis. Thorax 65 (suppl 1), i1–i58.Google Scholar
Spurgeon, P, Hicks, C, Barwell, F, Walton, I, Spurgeon, T (2005). Counselling in primary care: A study of the psychological impact and cost benefits for four chronic conditions. European Journal of Psychotherapy, Counselling and Health 7, 269–290.Google Scholar
Xu, W, Collet, J-P, Shapiro, S, Lin, Y, Yang, T, Platt, RW (2008). Independent effect of depression and anxiety on chronic obstructive pulmonary disease exacerbations and hospitalizations. American Journal of Respiratory and Critical Care Medicine 178, 913–920.Google Scholar
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