1 / 16

Everyday evidence – therapy outcomes in Swedish public health service settings

Everyday evidence – therapy outcomes in Swedish public health service settings. SPR 42nd annual meeting Bern, June 31, 2011 Andrzej Werbart & Lars Levin. Background. Dodo bird & Equivalence paradox Empirically supported treatment (EST) Randomized controlled trials (RCT) Pro’s & con’s

paley
Download Presentation

Everyday evidence – therapy outcomes in Swedish public health service settings

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Everyday evidence – therapy outcomes in Swedish public health service settings SPR 42nd annual meeting Bern, June 31, 2011 Andrzej Werbart & Lars Levin

  2. Background • Dodo bird & Equivalence paradox • Empirically supported treatment (EST) • Randomized controlled trials (RCT) • Pro’s & con’s • Evidence based practice in psychotherapy (EBPP) • QAPS

  3. Research questions • To investigate which patients get which treatment – comparing pre-treatment characteristics • Total sample and by therapy type • To compare outcomes from different forms of psychotherapy (CBT, PDT, INT) • Replication of prior studies (CORE) • To investigate whether different measures capture different aspects of change

  4. Method • Data collection 2007-2010 • Participants • 13 outpatient services • 1,500 pre-therapy questionnaires • Attrition • Procedure • Self-ratings: SCL-90, QOLI (SRH, HAQ, CSQ) • Therapist assessments • Treatment methods: CBT, PDT, INT • Statistical analysis • Cohen’s d, RCSI

  5. All patients where data at t1 is available N=1,498 Treatment starters n=1,294 (86.38%) Non-starters n=204 (13.62%) Remaining n=499 (33.31%) DO from treatment n=260 (17.36%) DO from data collection n=535 (35.71%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Other or unspecified therapy type n=8 Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176 Attrition

  6. Differences DO from treatment slightly younger DO from data collection more men slightly fewer previous psychiatric contacts Self-ratings – no significant differences Large groups Analysis of attrition All patients where data at t1 is available N=1,498 Treatment starters n=1,294 (86.38%) Non-starters n=204 (13.62%) Remaining n=499 (33.31%) DO from treatment n=260 (17.36%) DO from data collection n=535 (35.71%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Other or unspecified therapy type n=8 Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176

  7. Characteristics - by therapy type • Three groups (n=350) • CBT 63, PDT 206, INT 59 (22 other) • No significant differences regarding: • Gender (ca 70% female) • Self-rating • Significant differences: • Age (INT younger, M=24.7 yrs vs 32.2 & 32.3) • Level of education (INT less educated) • Occupation • Previous psychiatric contacts (CBT more)

  8. Self-rating - by therapy type

  9. All patients where data at t1 is available N=1,498 Treatment starters n=1,294 (86.38%) Non-starters n=204 (13.62%) Remaining n=499 (33.31%) DO from treatment n=260 (17.36%) DO from data collection n=535 (35.71%) Completed therapies n=188 (12.55%) Ongoing therapies n=311 (20.76%) Other or unspecified therapy type n=8 Core group n=180 Complete data t1 SCL-90: n=177 QOLI: n=178 Complete data t2 SCL-90: n=175 QOLI: n=176 Results - core group, effectiveness

  10. Results, core group- Effect size by therapy type

  11. Results, core group- RCSI & RC by therapy type (GSI)

  12. Results, core group- RCSI & RC by therapy type (QOLI)

  13. Discussion • Psychotherapy in public health services is effective for patients who complete treatment • Cohen’s d 0.81 (GSI), 0.78 (QOLI) • Clinical improvement larger when measured by GSI (54.8%) compared to QOLI (21.3%) • Differences toward UK studies (CORE) • Cohen’s d 1.39, RCSI=58.3% • Different patients (primary care vs outpatient psychiatric services)

  14. Discussion • The different therapy methods did not differ significantly in effectiveness • But effective for different aspects? • Symptom (SCL-90) vs Quality of Life (QOLI) • Systematic distribution of patients to treatments or therapists? • Dose-effect: longer treatment necessary for changes in quality of life? • Effects after termination?

  15. Further research • Dropouts • Non-starters • Non-responders • Welcome to the poster session tonight!

  16. Questions or comments? • Andrzej Werbartandrzej.werbart@sll.se • Lars Levinlars.levin@sll.se

More Related