IAPT

1
IAPT the New Kid on the Block?

• Dr Alan Cohen FRCGP
• National Primary Care Advisor

2
Overview
Long Term Conditions
Medically Unexplained Symptoms
3
(No Transcript)
4
Risk Profiling - Diabetes

• Depression is 2 3 times as common in people
  with diabetes
• Associated with
• Increased health care consumption
• Increased self perceived symptom load
• NOT associated with improved glycaemic control?

5
Potential Efficiency Savings

• Cost of treating diabetes is 250 greater when
  the patient has depression
• Cost of all treatments in people with diabetes
  is 400 greater when depression is co-morbid
• Proportion of NHS hospital expenditure on
  diabetes is 10 of total spend
• QOF indicator

6
Risk Profiling - IHD

• Depression is 2 3 times as common in people
  with ischaemic heart disease
• The best predictor of death following MI is the
  presence of depression
• QOF indicator

7
Potential Efficiency Savings

• 40 of admissions can be prevented by providing
  psychological treatments
• 50 of revascularisation procedures (CABG and
  PTCA) can be prevented by providing psychological
  treatments

8
Risk Profiling - Anxiety

• Anxiety occurs in 25 of people with COPD
• People with COPD make up the largest group of
  frequent flyers
• A fear of becoming of short of breath, or
  actually becoming short of breath?

9
Other conditions to be considered for this model
of care

• ENT
• Pain clinics
• AE
• Cancer

• Neurology
• Gynaecology
• Gastroenterology

10
NICE Guidelines for Depression in LTC
11
A few examples

• Chesterfield
• Hillingdon/Merton/Whittington

12
Chesterfield
13
Chesterfield Results

• 25 patients -2 cohorts
• 6 x PCI saved
• 3 x CABG saved
• 1 Angiogram
• All improved with programme

14
Savings

• 43,888 in procedures ( not including a
  transplant )
• 40,221 on hospital activity
• Total 84,109

15
After Cost

• 25 Patients 52,250
• Overall saving 31,859
• 1,274 per patient

16
Hillingdon
17
Hillingdon
18
Hillingdon

• Cost of admissions (6 month period)
• Intervention 71,799
• Control 128,344

19
Medically Unexplained Symptoms

• 20 of Primary Care consultations are for people
  with medically unexplained symptoms
• 50 of OPD appointments are for people with
  medically unexplained symptoms

20
Primary Care

• Nottingham Medical School have delivered a
  commissioning tool for practice based
  commissioners
• It is NOT validated to identify individuals
• It uses the practice data base to identify people
  who are likely to have MUS

21
How many?

• Factors included
• Age
• Chronic fatigue
• Life stress
• Long term illness
• Negative ESR
• Anti-depressants
• Z -1.9269 -0.0292(X1) 1.7709(X2)
  0.6125(X3) 0.8156(X4) 0.8648(X5) 0.9476(X6)
  

22
How many severe patients?

• Factors
• Age
• Anti-depressants
• Dryness
• Obesity
• Sleep problems
• Negative ESR
• Life stress
• Asthma
• Z -3.3399 -0.0106(X1) 1.2742(X2)
  0.9175(X3) -0.7362(X4) 0.6755(X5) 1.1049(X6)
  1.1388(X7) 0.5055(X8)
• www.iapt.nhs.uk and search for MUS The
  Nottingham Tool

23
Acute OPD
Prevalence of MUS in acute out patients in a
London Teaching Hospital

• Clinic
• Chest 59
• Cardiology 56
• Gastroenterology 60
• Rheumatology 58
• Neurology 55
• Dental 49
• Gynaecology 57

24
Cost to the NHS
Resource Element Sub-threshold somatisation ( million) Somatisation disorder ( million) Total ( million)
Primary Care Consultations 732 276 1,008
Prescriptions 315 88 403
OPD Care Referrals 41 42 83
Follow up 267 27 294
In-patient care Bed days 693 610 1,303
AE 32 23 54
Health care 3,145
Output losses Sick days 4,784 451 5,235
Quality of Life QALYs lost 8,371 876 9,348
Total Burden 17,728
Bermingham et al in press
25
Summary

• LTCs and MUS is costing the NHS lots of money
• We know that psychological support will influence
  outcomes
• What are you doing about it?

26
Thank you

• Alan.cohen_at_dh.gsi.gov.uk