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The effect of service setting on treatment outcome: A comparison between primary and secondary care

Fortune, L. (2003). The effect of service setting on treatment outcome: A comparison between primary and secondary care. (Unpublished Doctoral thesis, City, University of London)


Background: Within the NHS there has been an increasing emphasis placed on the integration of mental health service within primary care. It is suggested that mental health services within primary care can offer more benefits to the patient and the professionals involved. Research into the effectiveness of mental health services in primary care has produced equivocal results, the most positive outcomes have been in CBT treatment for depression, with one RCT implying that primary care treatment may produce more rapid recovery than secondary care treatment.
Aim: The aim of this study was to compare a primary care CBT service with a similar secondary care service, to investigate differences in the rate of recovery and participant satisfaction.

Method: The study was carried out in a primary care psychology service that provides treatment within 6 GP surgeries and one psychiatric hospital in south London. A quasi experimental design was used to compare 52 participants who received CBT treatment for a variety of psychological problems in either a primary care or secondary care setting. A range of psychological measures were taken at baseline and over the first six treatment sessions, to compare the rate of change in psychological symptoms. Consumer satisfaction was also measured at week 6 and a follow up questionnaire was used to explore the participants’ attitude towards the contextual differences of the settings.

Results: Both groups demonstrated improvement over the period of the study but the participants from the Primary Care group showed a more rapid rate of recovery during the first six sessions. The Primary Care group also reported significantly higher levels of satisfaction than the secondary care group. The follow up questionnaire demonstrated that the primary care setting was associated with increased acceptability and accessibility and less stigma than the secondary care setting.

Conclusions: Patients receiving CBT may respond more rapidly to treatment provided in primary care rather than secondary. Providing a service in primary care might also increase patient compliance with treatment. But further research is needed to investigate the longer term outcome.

Publication Type: Thesis (Doctoral)
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Departments: School of Health & Psychological Sciences > Psychology
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
Doctoral Theses
[thumbnail of Fortune thesis 2003 PDF-A.pdf]
Text - Accepted Version
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