Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-21T11:12:17.101Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost–benefit analysis of a controlled trial of nurse therapy for neuroses in primary care

Published online by Cambridge University Press:  09 July 2009

Gary Ginsberg ,
Isaac Marks  and
Helena Waters
Gary Ginsberg
Affiliation:
From the Institute of Psychiatry, London
Isaac Marks*
Affiliation:
From the Institute of Psychiatry, London
Helena Waters
Affiliation:
From the Institute of Psychiatry, London
*
1Address for correspondence: Professor Isaac Marks, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

In a randomized, controlled trial neurotic patients (mainly phobics and obsessive-compulsives) in primary care were assigned to behavioural psychotherapy from a nurse therapist or to routine care from their general practitioner. At the end of one year clinical outcome was significantly better in patients cared for by the nurse therapist. Economic outcome to one year, compared with the year before entering the trial, showed a slight decrease in the use of resources by the nurse therapist group (N = 22), and an increase in resource usage in the GP-treated group (N = 28), mainly due to the letter's increased absence from work and more hospital treatment and drugs. On the reasonable assumptions that nurse therapists treat 46 patients a year and that such patients treated behaviourally maintain their gains for 2 years, the economic benefits to society from nurse therapists treating such patients may outweigh the costs. This excludes any monetary value on the substantial clinical gains such as reduction in fear and anxiety. However, the numbers are small, few economic differences were significant, and many patients either did not complete the trial or waiting-list periods or they failed to return economic data. Conclusions must thus be tempered with caution, even though pre-treatment demographic and clinical data of non-returners were comparable with those of returners, and though the few drop-outs who could be rated at one year had not improved. The findings cannot be extrapolated to other types of clinical problem and treatment.

Type
Research Article
Information
Psychological Medicine , Volume 14 , Issue 3 , August 1984 , pp. 683 - 690
Copyright
Copyright © Cambridge University Press 1984

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Agras, W. S., Chapin, N. & Olivear, D. C. (1972). The natural history of phobia: course and prognosis. Archives of General Psychiatry 26, 315–317.CrossRefGoogle ScholarPubMed
Binner, P., Halpern, J. & Potter, A. (1973). Patients, programs and results in a comprehensive mental health centre. Journal of Consulting and Clinical Psychology 41, 148–156.CrossRefGoogle Scholar
Bird, J., Marks, I. M. & Lindley, P. (1979). Nurse therapists in psychiatry: Some developments, controversies and implications. British Journal of Psychiatry 135, 321–329.CrossRefGoogle ScholarPubMed
Boudewyns, P. A. (1974). Is ‘Milieu Therapy’ in a short-term in-patient psychiatric setting worth the money? International Mental Health Research News 16, 7.Google Scholar
Boulougouris, J. C. (1977). Behaviour modification of obsessive compulsives treated by flooding. In Treatment of Phobic and Obsessive-compulsive Disorders (ed. Boulougouris, J. C. and Rabavilas, A. D.), pp. 73–84. Pergamon Press: Oxford.Google Scholar
Cassell, W. A., Smith, C., Grunbere, F., Boan, J. A. & Thomas, R. F. (1972). Comparing costs of hospital and community care. Hospital and Community Psychiatry 23, 197.Google ScholarPubMed
Cochrane, A. L. (1971). Effectiveness and Efficiency, pp. 57–60. The Nuffield Provincial Hospitals Trust: London.Google Scholar
Eimerl, T. S. & Pearson, R. J. C. (1966). Working time in general practice. How general practitioners use their time. British Medical Journal ii, 1549–1554.CrossRefGoogle Scholar
Emmelkamp, P. M. G. (1982). Phobic and Obsessive-compulsive Disorders. Plenum: New York.CrossRefGoogle Scholar
Emmelkamp, P. M. G. (1983). Obsessive-compulsive disorders: a follow-up.In Proceedings of VII World Congress of Psychiatry. WPA:Vienna. (In the press.)Google Scholar
Ginsberg, G. & Marks, I. M. (1977). Costs and benefits of behavioural psychotherapy: a pilot study of neurotics treated by nurse therapists. Psychological Medicine 7, 685–700.CrossRefGoogle ScholarPubMed
Hoult, J., Reynolds, I., Charbonneau-Powis, M., Weekes, P. & Briggs, J. (1983). Psychiatric hospital versus community treatment: the results of a randomised trial. Australian and New Zealand Journal of Psychiatry 17, 160–170.CrossRefGoogle ScholarPubMed
Jones, K. et al. (1961). Cost and efficiency in mental hospitals. The Hospital 57, 23.Google Scholar
Karon, B. P. & Vanden Bos, G. R. (1975). Treatment costs of psychotherapy versus medication for schizophrenics. Professional Psychology 6, 293.CrossRefGoogle Scholar
Karon, B. P. & Vanden Bos, G. R. (1976). Cost benefit analysis: psychologist versus psychiatrist for schizophrenics. Professional Psychology 7, 107.CrossRefGoogle Scholar
Marks, I. M. (1971). Phobic disorders 4 years after treatment. British Journal of Psychiatry 118, 683–688.CrossRefGoogle Scholar
Marks, I. M. (1981). Cure and Care of Neuroses. John Wiley & Sons: New York.Google Scholar
Marks, I. M. & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy 17, 263–267.CrossRefGoogle ScholarPubMed
Marks, I. M., Hallam, R. S. & Connolly, J. C. (1975). Nurse therapists in behavioural psychotherapy British Medical Journal iii, 144–148.CrossRefGoogle Scholar
Marks, I. M., Hallam, R. S., Connolly, J. C. & Philpott, R. (1977). Nursing in Behavioural Psychotherapy. An Advanced Clinical Role for Nurses. Royal College of Nursing: London.Google Scholar
Marks, I. M., Bird, J. & Lindley, P. (1978). Behavioural nurse therapists – developments and implications. Behavioural Psychotherapy 6, 25–36.CrossRefGoogle Scholar
Marks, I. M., Waters, H. & Lindley, P. (1983). Nurse therapy in primary care: a controlled clinical and epidemiological study. Report to DHSS, 10.Google Scholar
Marks, I. M., Waters, H. & Lindley, P. (1984). Nurse therapists in primary care. Submitted for publication.Google Scholar
Marston, A. R., Marston, & Ross, (1977). A correspondence course behavioural program for weight reduction. Obesity/Bariatric Medicine 6, 140.Google Scholar
McCaffree, K. M. (1966). The cost of mental health care under changing treatment methods. American Journal of Public Health 56, 1013.CrossRefGoogle ScholarPubMed
McPherson, F. M., Brougham, L. & McLaren, S. (1980). Maintenance of improvement in agoraphobic patients treated by behavioural methods. Four year follow-up. Behaviour Research and Therapy 18, 150–152.CrossRefGoogle Scholar
Munby, M. & Johnston, D. W. (1980). Agoraphobia: the long term follow-up of behavioural treatment. British Journal of Psychiatry 137, 418–427.CrossRefGoogle Scholar
Murphy, J. & Datel, W. (1976). A cost–benefit analysis of community versus institutional living. Hospital and Community Psychiatry 27, 165.Google ScholarPubMed
Paykel, E., Mangen, S. P., Griffith, J. H. & Burns, T. P. (1983). Community Psychiatric Nursing for Neurotic Patients. Royal College of Nursing: London.Google Scholar
Rubenstein, J. S., Armentrout, J. A., Levin, S. & Herald, D. (1978). The parent–therapist program: alternative care for emotionally disturbed children. American Journal of Orthopsychiatry 48, 654–662.CrossRefGoogle ScholarPubMed
Stern, B. E. & Stern, E. S. (1963). Efficiency of mental hospitals. British Journal of Preventive and Social Medicine 17, 111–120.Google ScholarPubMed
Wadsworth, W. V., Tonge, W. L. & Barber, L. E. D. (1957). Cost of treatment of affective disorders: a comparison of three hospitals. Lancet ii, 533–534.CrossRefGoogle Scholar
Washburn, S., Vanicelli, M., Longabaugh, R. & Sheff, B. J. (1976). A controlled comparison of psychiatric day treatment and inpatient hospitalization. Journal of Consulting Clinical Psychology 44, 665–675.CrossRefGoogle ScholarPubMed
Watson, D. L. & Tharp, R. G. (1972). Self-directed Behaviour: Self Modification for Personal Adjustment. Brooks/Cole: Belmont, CA.Google Scholar
Weisbrod, B. D. (1982). A guide to benefit–cost analysis, as seen through a controlled experiment in treating the mentally ill. Journal of Health Politics, Policy and Law 7, 808–845.CrossRefGoogle Scholar
Williams, R. L. & Lang, J. D. (1979). Toward a Self-managed Lifestyle (2nd edn). Houghton Mifflin: Boston, Mass.Google Scholar
Yates, B. T. (1978). Improving the cost effectiveness of obesity programs: three basic strategies for reducing the cost per pound. International Journal of Obesity 2, 249.Google ScholarPubMed
Yates, B. T. (1980). Improving Effectiveness and Reducing Costs in Mental Health. C. C. Thomas: Springfield, Ill.Google Scholar