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Review: Primary care counseling improves psychological symptoms in patients with psychological and psychosocial problems

Philip J. Baty, MD
[+] Article, Author, and Disclosure Information

Sources of funding: University of Leeds and Manchester University.

For correspondence: Ms. N. Rowland, Bootham Park Hospital, York, England, UK. E-mail Nancy.Rowland@excha.yhs-tr.northy.nhs.uk.

Ann Intern Med. 2002;136(3):108. doi:10.7326/ACPJC-2002-136-3-108
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Question: In patients with psychological and psychosocial problems, is counseling in primary care effective and cost-effective?

Data sources: Studies were identified by searching databases including MEDLINE; EMBASE/Excerpta Medica; PsycLIT; CINAHL; the Cochrane Library; and the Cochrane Collaboration Depression, Anxiety, and Neurosis Register of Randomized Controlled Trials (RCTs) and controlled clinical trials (for trials completed by April 1998). Search terms included primary health care, counseling, psychotherapy, general practice, and clinical psychology. A specialist journal was hand searched, bibliographies of relevant studies were scanned, and experts were contacted.

Study selection: Published and unpublished studies in all languages were selected if they were RCTs; examined patients with psychological or psychosocial problems who were suitable for counseling; used a clear definition of counseling compatible with that of the British Association of Counselling; used counseling offered by trained practitioners; included outcomes of clinical effectiveness, patient satisfaction, and health service utilization; and compared counseling with a control therapy. Trials of patients on psychotropic drugs in addition to counseling were included if a direct comparison could be made between therapies. Exclusion criteria were specialist counseling or structured therapies (e.g., cognitive behavioral therapy, behavioral therapy, and problem-solving therapy).

Data extraction: Data were extracted on methodologic quality, participants, type and duration of interventions, and outcomes and cost-effectiveness.

Main results: 4 English-language RCTs (678 patients) using up to 12 sessions of face-to-face counseling of individual patients offered by a range of trained practitioners met the selection criteria. Follow-up ranged from 6 weeks to 9 months. Results focused on post-treatment follow-up (6 to 12 wk). Data on psychological symptom levels were pooled from the 4 RCTs; patients receiving counseling had better psychological symptom levels than did those receiving usual care (standardized mean difference −0.30, 95% CI −0.49 to −0.11). 3 RCTs reported generally high patient-satisfaction levels with counseling. No clear difference was shown between counseling and usual care for health service utilization (4 RCTs) or cost-effectiveness (1 RCT).

Conclusions: In patients with psychological and psychosocial problems, counseling in primary care improves psychological symptom levels. Patient satisfaction with counseling seems to be high. Data are lacking on the cost-effectiveness of counseling.





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