An evaluation of the clinical effectiveness of a counselling psychology service in primary care

Abstract

This paper describes an evaluation of the clinical effectiveness of a counselling psychology service in primary care, by a comparison of SCL-90R and HAD scores of a group of clients in treatment with those of a control group receiving general practitioner-only care, at four points in time; and with scores while waiting for treatment. The design combined elements of an open trial with elements of a randomised controlled trial, although full randomisation was not possible in practice. The results are expressed in terms of numbers of cases and effect size, as well as in terms of test scores, in an attempt to indicate levels of clinical as well as statistical significance. A comparison of number of visits made to general practitioners by participants in each group during the six months before and after treatment was also carried out. The results indicate that the service was clinically effective: compared to the control condition, the treated clients did better on all indicators, but the difference between the two groups was not great enough to show statistical significance at the 0.1 per cent level required by the use of multiple planned t-tests, or on MANOVA, although on the major indicators (SCL-90R GSI and HAD Depression and Anxiety) significance was reached at the 5 per cent level. The overall effect size was 0.32. The paper also discusses the methodological issues and difficulties in carrying out such outcome studies in primary care.