A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector

Objectives To compare outcome and resource utilisation among patients refer red to the Amalthea Project, a liaison organisation that facilitates contac t between voluntary organisations and patients in primary care, with patien ts receiving routine general practitioner care. Design Randomised controlled trial with follow up at one and four months. Setting 26 general practices in Avon. Participants 161 patients identified by their general practitioner as havin g psychosocial problems. Main outcome measures Primary outcomes were psychological wellbeing (assess ed with the hospital anxiety and depression scale) and social support (asse ssed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functiona l health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of pr escribing in primary care, and cost of referrals to other agencies, over fo ur months. Results The Amalthea group showed significantly greater improvements in anx iety (average difference between groups after adjustment for baseline -1.9, 95% confidence interval -3.0 to -0.7), other emotional feelings (average a djusted difference -0.5, -0.8 to -0.2), ability to carry out everyday activ ities (-0.5, -0.8 to -0.2), feelings about general health (-0.4, -0.7 to -0 .1), and quality of life (-0.5, -0.9 to -0.1). No difference was detected i n depression or perceived social support. The mean cost was significantly g reater in the Amalthea arm than the general practitioner care arm (pound 15 3 v pound 133, P = 0.025). Conclusion Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with us ual general practitioner care in managing psychosocial problems, but at a h igher cost.