Implementing the Accessible Depression and Anxiety Psychological Therapies for Long Term Conditions (ADAPT-LTC)...

While the National Health Service (NHS) in the United Kingdom (UK) is increasing provisions for psychological interventions in primary care for patients with long-term conditions (LTCs), there is limited knowledge of effective implementation. This study reports on outcomes of an open pilot trial implementing the Accessible Depression and Anxiety Psychological Therapies for Long Term Conditions (ADAPT-LTC) programme in Scottish primary care services.

This study entails a pragmatic, real-world implementation evaluation of ADAPT-LTC in primary care using data collected from routine outcome monitoring. Analysis focused on implementation (feasibility, suitability), service (clinical outcomes) and client (care experiences and satisfaction) outcomes. Rates of recovery, reliable improvement, reliable recovery and reliable deterioration were used as indicators of clinical outcomes.

Approximately half of referred patients progressed to treatment. Patient engagement in treatment was split into groups of patients who attended few treatment sessions (approximately <4 sessions) or patients who accessed 6-8 sessions or more. Among patients who participated in treatment, CBT was associated with large pre- to post-treatment effects in reducing depression, anxiety, and functional impairment, with 35%-40% of patients no longer meeting criteria for psychiatric diagnosis and 60% reporting clinically reliable improvements. Patients reported positive care experiences and satisfaction.

Delivering brief psychological intervention in primary care was effective for most patients with LTCs. However, a subgroup of patients did not start treatment or struggled to attend treatment suggesting the programme may not be suitable for all patients. Methods for enhancing engagement and implementation of ADAPT-LTC are discussed.