IAPT LTC/MUS Pathfinder Evaluation Project:
Interim Report
IAPT LTC/MUS Pathfinder Event
21st March 2013
Prof Simon de Lusignan
Prof Simon Jones
Dr Niall McCrae
Dr Granham Cookson
Dr Tom Chan
Ana Correa
www.clininf.eu
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Background
IAPT is designed to reduce:
• Disease burden to the individual
• Economic burden to the society of common mental health
problems (CMHP)
The costs of depression and chronic anxiety (Laylard 2006)
• Lost of output (unemployment and absence from work) £12
billions
• To the tax payers (benefits and lost of tax) £7 billions
• Costs of a ‘proper therapy service’ – £0.6 billion
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Pathfinder teams were tasked
with identifying:
• Potential optimal stepped care pathway for people with
LTC/MUS
• Core therapy competencies, experiences and training
required to deliver therapies to people with LTC/MUS &
anxiety and depression
• Potential improvement in economic factors in health
utilisation across primary and secondary care
• Potential clinical effectiveness and improvement in
condition by providing therapies to people with LTC/MUS
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Progress to-date
• Governance arrangements –
– Steering Board – seeking representative from pathfinders, users and
commissioning groups
– Operational Team
– Regular contacts/reports with DH IAPT
• Evaluation plan - revised after consultation
• IAPT LTC/MUS Learning events – insight into contextual information
• Site visits – Piloted a info gathering schedule in Southwark & Bexley
– Have visited (or arranged to visit) 5 pathfinders
• Patient experience survey - Consulted DH IAPT & pathfinders
– Starting survey in March 2013
• Data collection for quantitative analysis – working with DH IAPT
– Local IAPT data will be linked to HES (& anonymised) by NHS IC
– Designed data template
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Revised evaluation plan:
• Qualitative – site visits, discussions and available documents
– Overview of services
– Care pathway analysis
– Workforce analysis
• Quantitative – IAPT MDS, HES, & additional outcome measures
– Analysis – size of services, referrals, and outcomes (e.g. changes in
PHQ9 and other measures)
– Economic analysis – utilisation of healthcare services, mapping
W&SAS onto EQ5D
• Patient experience survey – modified version of National IAPT PEQ
– Survey of all new referral between Mid March to Mid-June 2013
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Findings and observation to-date:
Source of information
Routinely collected IAPT LTC/MUS data– not yet available; and
site visits – not yet completed
Source of information: • From the DH IAPT Team
– Copies of pathfinder application
– Available project administration and management records – e.g.
overview of info system in use, key communications between DH
and pathfinders
• From the pathfinders
– Presentations at learning events
– Self-reported data/information
– Informal discussions and e-mail correspondences
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Findings and observation to-date:
• Impressive breadth of service models
• Practitioners and managers are motivated and enthusiastic
about the pilot projects
• Pathfinder status - gives local services space and time to
apply research evidence systematically in practice across
organisational boundaries (e.g. Oxfordshire Heart2heart and
Buckinghamshire BreatheWell Project)
• Anecdotal and documented evidence of effectiveness (e.g.
Berkshire West Diabetes Project running a randomised trial; positive
lient feedback in Oxfordshire and in Buckinghamshire)
• Workforce competence and training – a number of pathfinders
have devised training materials and self-help guides in primary and
secondary care (e.g. Southwark and Bexley Pathfinder)
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Findings and observation to-date:
•
•
•
•
•
Some delays in getting the pilot projects up and running
Uncertainty about future funding and consequent planning
Scepticism about the accuracy of CSRI
Concerns about burdensome forms and measures
Some data issues: – Majority use PC-MIS or IAPTus to record IAPT MDS – 5 pathfinders
did not document using either system
– Other measures (e.g. EQ-5D, CSRI and other conditions specific
measures) are collected through local CCG supported databases or
stand alone spreadsheets
– Self-reported data compliance in Oct 2012 varied between 100% and
0% (2/3 reported compliance of 75% or above)
– PHQ and EQ-5D scores are sometimes recorded at aggregated level
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Conclusion and recommendations:
The common themes observed –
• Application of research evidence in clinical practice - ‘holistic
mind and body medicine’
• Development of training programmes for practitioners and
self-help guides for clients
• Development of local clinical networks and integrated care
pathways
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Conclusion and recommendations:
• Impressed by the innovation and commitment of the
pathfinders
• Holistic care – not just delivering CBT
• Excellent anecdotal feedback from some clients
– ‘it has changed my life’
• Certainty about Phase 2 would help
• Phase 2, if supported, should mandate a more specific data
template and migration of stand alone spreadsheets to a
more auditable data system
• Consider HES IAPT linkage as part of the routine service
monitoring as an alternative to CSRI
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Thanks for listening
Contacts: - t.chan@surrey.ac.uk
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