This is not the most recent version of the article. View current version (7 SEP 2011)
Intervention Review
Effectiveness and cost effectiveness of counselling in primary care
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 23 MAY 2006
DOI: 10.1002/14651858.CD001025.pub2
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Database Title
Additional Information
How to Cite
Bower PJ, Rowland N. Effectiveness and cost effectiveness of counselling in primary care. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001025. DOI: 10.1002/14651858.CD001025.pub2.
Publication History
- Publication Status: Edited (no change to conclusions)
- Published Online: 21 JAN 2009
This is not the most recent version of the article.View current version (07 Sep 2011)
Abstract
Background
The prevalence of mental health and psychosocial problems in primary care is high. This review examines the clinical and cost-effectiveness of psychological therapies provided in primary care by counsellors.
Objectives
To assess the effectiveness and cost effectiveness of counselling in primary care by reviewing cost and outcome data in randomised controlled trials for patients with psychological and psychosocial problems considered suitable for counselling.
Search strategy
To update the review, the following electronic databases were searched on 25-10-2005: MEDLINE, EMBASE, PsycLIT, CINAHL, the Cochrane Controlled Trials register and the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers.
Selection criteria
All controlled trials comparing counselling in primary care with other treatments for patients with psychological and psychosocial problems considered suitable for counselling. Trials completed before the end of June 2005 were included in the review.
Data collection and analysis
Data were extracted using a standardised data extraction sheet. Trials were rated for quality using CCDAN criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form.
Main results
Eight trials were included in the review. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar.
Authors' conclusions
Counselling is associated with modest improvement in short-term outcome compared to usual care, but provides no additional advantages in the long-term. Patients are satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs.
Plain language summary
Counselling for psychological and psychosocial problems in primary care
Counselling for psychological problems is better than usual general practitioner care. People who receive counselling in primary care from a trained counsellor are more likely to feel better immediately after treatment and be more satisfied than those who receive care from their general practitioner. However, in the long term, counselling is not any better than GP care. Patients are satisfied with counselling. Although some types of healthcare utilisation may be reduced, counselling does not seem to reduce overall healthcare costs.