A RANDOMIZED CONTROLLED TRIAL AND ECONOMIC-EVALUATION OF COUNSELING IN PRIMARY-CARE

Background. Counselling in primary care settings remains largely uneva luated. Such evaluation has been strongly recommended. Aim. To determi ne the relative effectiveness and cost-effectiveness of generic counse lling and usual general practitioner (GP) care for patients with minor mental health problems. Method. A randomized controlled trial and hea lth economic evaluation were carried out in nine general practices. Ac cess to generic counselling (brief counselling, generally involving up to six 50-minute sessions) was compared with usual GP care. A total o f 162 patients aged 16 years and over with diverse mental health probl ems (excluding phobic conditions and psychoses) were randomized. The H ospital Anxiety and Depression (HAD) scale, COOP/WONCA (World Organiza tion of Family Doctors) functional health assessment charts, and the d elighted-terrible faces scale were used to assess outcome four months after randomization. Results. The two groups were similar at baseline. There were significant improvements in both groups between randomizat ion and follow-up for most outcome measures, but no significant differ ences between the study arms. The 95% confidence limits were narrow an d excluded clinically significant effects. Under various assumptions c oncerning the cost of secondary care referrals and of counselling time , no clear cost advantage was associated with either intervention. Con clusions. This pragmatic trial demonstrates no difference in functiona l or mental health outcome at four months between subjects offered acc ess to counselling and those given usual care by their GP. There is no clear difference in the cost-effectiveness of the two interventions. Purchasers should take account of these findings in allocating resourc es within primary care.