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What factors are associated with improvement after brief psychological interventions in primary care? Issues arising from using routine outcome measurement to inform clinical practice

Abstract:

Study purpose: This descriptive study used a routine practice dataset to investigate whether demographic variables and intervention length were associated with outcome after brief psychological interventions in primary care. Brief description of the participants: The data are from 3687 adults with a wide range of presenting problems, from a culturally diverse inner London borough, referred to primary care psychologists and counsellors. Methodology: Demographic and service activity data were routinely collected using a local monitoring form and self-report outcome data using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The paradigm of reliable and clinically significant change was used to explore individual as well as group change. The relationship between demographic variables, intervention length and outcome was investigated. Results, conclusions and implications: Sixty-six per cent of the group with complete outcome data (n = 458) showed reliable improvement and 45% also showed clinically significant improvement after the intervention. Ethnicity was not related to outcome, suggesting that the service was not culturally biased in this respect (although clients from ethnic minorities were significantly underrepresented in the sample of clients who attended). Women and employed clients were more likely to show improvement. Unemployed men had comparatively poor outcomes. There was a positive relationship between length of intervention and improvement. As is often the case, client and data attrition were high: the small sample for which complete outcome data were available reduced the representativeness and generalisability of the findings which must therefore be treated with caution. Issues of attrition must be addressed in future to ensure that data quality is sufficient to increase confidence in using it for service management, development and ‘benchmarking’. However, the study adds to the growing body of ‘practice-based evidence’ supporting the provision of primary care psychology and counselling services. The findings suggest that the employment status and gender of clients may both need to be considered when ‘benchmarking’ outcomes.