Helping urgent care users cope with distress about physical complaints.
Each year many people make use of Accident & Emergency departments, walk in centres or make an urgent same day appointment with their GP. This is "unscheduled care". Doctors may be unable to tell these patients what exactly is causing their symptoms, which can be painful and cause distress if they are not able to be treated.
We want a better understanding of the needs of patients who use unscheduled care, and to find out whether Cognitive Behavioural Therapy (CBT) over the phone or via video calling is acceptable and effective in improving physical and emotional health. We will:
- investigate whether talking therapy given remotely is clinically or cost effective compared to usual care
- find the best way of delivering this treatment by talking with service users, health professionals, other experts and researchers
- find the best way of putting the intervention into ordinary NHS practice across the East Midlands and other regions of the country.
Why is this study important?
Six percent of the population have excessive anxiety about their health. A recent study showed that health anxiety and medically unexplained symptoms (MUS) may cost the NHS in England an estimated £3 billion per year in unnecessary costs. Despite much of this money being spent on unplanned or urgent care and in-patient admission there is little evidence of patient benefit.
Therefore, reduction in unnecessary use of urgent and emergency care is a government priority. Partly in recognition of the high use of medical care and how common and unpleasant health anxiety is, the Department of Health is spending additional resources to provide talking therapy for patients with severe health anxiety.
At present Improving access to Psychological Therapies (IAPT) services provide CBT for health anxiety but there has been little take up of this nationally. In previous CLAHRC research, patients with health anxiety were reluctant to accept face-to-face talking treatment from mental health services.
There is good evidence of the clinical and cost effectiveness of brief CBT for health anxiety carried out in secondary care medical settings, specialist psychological treatment or US community settings. The Cognitive Behavioural Therapy for Health Anxiety in Medical Patients (CHAMP) study found that new ways of self-management through CBT showed reductions in health anxiety which were maintained for at least 2 years.
Previous research suggests that remote delivery of therapy is just as effective as giving treatment face-to-face for people with depression and anxiety. Remote delivery might be more acceptable to patients with health anxiety. It is also more cost effective and can be better supervised as it can be delivered by a smaller group of local experts who will be highly familiar with the needs of these patients.