Comparative Effectiveness of Cognitive Therapies Delivered Face-to-Face or over the Telephone: An Observational Study Using Propensity Methods
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{"title"=>"Comparative Effectiveness of Cognitive Therapies Delivered Face-to-Face or over the Telephone: An Observational Study Using Propensity Methods", "type"=>"journal", "authors"=>[{"first_name"=>"Geoffrey C.", "last_name"=>"Hammond", "scopus_author_id"=>"55372478400"}, {"first_name"=>"Tim J.", "last_name"=>"Croudace", "scopus_author_id"=>"6603726577"}, {"first_name"=>"Muralikrishnan", "last_name"=>"Radhakrishnan", "scopus_author_id"=>"7004745317"}, {"first_name"=>"Louise", "last_name"=>"Lafortune", "scopus_author_id"=>"6602247618"}, {"first_name"=>"Alison", "last_name"=>"Watson", "scopus_author_id"=>"57198608739"}, {"first_name"=>"Fiona", "last_name"=>"McMillan-Shields", "scopus_author_id"=>"55372523000"}, {"first_name"=>"Peter B.", "last_name"=>"Jones", "scopus_author_id"=>"56489064900"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84867013873", "pui"=>"365766176", "doi"=>"10.1371/journal.pone.0042916", "isbn"=>"1932-6203", "sgr"=>"84867013873", "pmid"=>"23028436"}, "id"=>"6dee9b21-69b6-38a9-8181-337df84c3081", "abstract"=>"OBJECTIVES To compare the clinical and cost-effectiveness of face-to-face (FTF) with over-the-telephone (OTT) delivery of low intensity cognitive behavioural therapy. DESIGN Observational study following SROBE guidelines. Selection effects were controlled using propensity scores. Non-inferiority comparisons assessed effectiveness. SETTING IAPT (improving access to psychological therapies) services in the East of England. PARTICIPANTS 39,227 adults referred to IAPT services. Propensity score strata included 4,106 individuals; 147 pairs participated in 1:1 matching. INTERVENTION Two or more sessions of computerised cognitive behavioural therapy (CBT). MAIN OUTCOME MEASURES Patient-reported outcomes: Patient Health Questionnaire (PHQ-9) for depression; Generalised Anxiety Disorder questionnaire (GAD-7); Work and Social Adjustment Scale (WSAS). Differences between groups were summarised as standardised effect sizes (ES), adjusted mean differences and minimally important difference for PHQ-9. Cost per session for OTT was compared with FTF. RESULTS Analysis of covariance controlling for number of assessments, provider site, and baseline PHQ-9, GAD-7 and WSAS indicated statistically significantly greater reductions in scores for OTT treatment with moderate (PHQ-9: ES: 0.14; GAD-7: ES: 0.10) or small (WSAS: ES: 0.03) effect sizes. Non-inferiority in favour of OTT treatment for symptom severity persisted as small to moderate effects for all but individuals with the highest symptom severity. In the most stringent comparison, the one-to-one propensity matching, adjusted mean differences in treatment outcomes indicated non-inferiority between OTT versus FTF treatments for PHQ-9 and GAD-7, whereas the evidence was moderate for WSAS. The per-session cost for OTT was 36.2% lower than FTF. CONCLUSIONS The clinical effectiveness of low intensity CBT-based interventions delivered OTT was not inferior to those delivered FTF except for people with more severe illness where FTF was superior. This provides evidence for better targeting of therapy, efficiencies for patients, cost savings for services and greater access to psychological therapies for people with common mental disorders.", "link"=>"http://www.mendeley.com/research/comparative-effectiveness-cognitive-therapies-delivered-facetoface-telephone-observational-study-usi", "reader_count"=>108, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>21, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>19, "Student > Postgraduate"=>5, "Student > Master"=>20, "Other"=>12, "Student > Bachelor"=>13, "Lecturer"=>2, "Professor"=>4}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>2, "Researcher"=>21, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>19, "Student > Postgraduate"=>5, "Student > Master"=>20, "Other"=>12, "Student > Bachelor"=>13, "Lecturer"=>2, "Professor"=>4}, "reader_count_by_subject_area"=>{"Unspecified"=>6, "Mathematics"=>1, "Medicine and Dentistry"=>32, "Agricultural and Biological Sciences"=>5, "Business, Management and Accounting"=>1, "Sports and Recreations"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>46, "Chemistry"=>1, "Social Sciences"=>8, "Computer Science"=>2, "Economics, Econometrics and Finance"=>3, "Environmental Science"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>32}, "Social Sciences"=>{"Social Sciences"=>8}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Psychology"=>{"Psychology"=>46}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>6}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Environmental Science"=>{"Environmental Science"=>1}, "Chemistry"=>{"Chemistry"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>3}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>2}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}}, "reader_count_by_country"=>{"Sweden"=>3, "United States"=>1, "United Kingdom"=>2}, "group_count"=>19}

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Figshare

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  • {"files"=>["https://ndownloader.figshare.com/files/566166"], "description"=>"<p>Note: Values in bold indicate significant associations (p<.01).</p>", "links"=>[], "tags"=>["characteristics", "ftf", "ott", "groups", "matched", "propensity"], "article_id"=>236650, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.t004", "stats"=>{"downloads"=>7, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Treatment_characteristics_and_course_in_FTF_versus_OTT_groups_matched_1_8758_1_on_the_basis_of_propensity_scores_/236650", "title"=>"Treatment characteristics and course in FTF versus OTT groups matched 1∶1 on the basis of propensity scores.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 22:23:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/566291"], "description"=>"<p>Patient characteristics in the five propensity score strata.</p>", "links"=>[], "tags"=>["characteristics", "propensity"], "article_id"=>236781, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.t003", "stats"=>{"downloads"=>6, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Patient_characteristics_in_the_five_propensity_score_strata_/236781", "title"=>"Patient characteristics in the five propensity score strata.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 22:24:20"}
  • {"files"=>["https://ndownloader.figshare.com/files/565730"], "description"=>"<p>Flow and selection of subject records for inclusion into naïve comparisons and propensity score analyses.</p>", "links"=>[], "tags"=>["records", "inclusion", "comparisons", "propensity"], "article_id"=>236206, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.g001", "stats"=>{"downloads"=>5, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Flow_and_selection_of_subject_records_for_inclusion_into_na_239_ve_comparisons_and_propensity_score_analyses_/236206", "title"=>"Flow and selection of subject records for inclusion into naïve comparisons and propensity score analyses.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 22:21:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/566334"], "description"=>"*<p>: Significant differences across treatment groups.</p>", "links"=>[], "tags"=>["characteristics", "patients", "receiving", "face-to-face", "predominantly"], "article_id"=>236819, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_demographic_clinical_and_functional_characteristics_of_patients_receiving_either_face_to_face_or_predominantly_telephone_based_treatments_/236819", "title"=>"Baseline demographic, clinical, and functional characteristics of patients receiving either face-to-face or predominantly telephone based treatments.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 22:24:31"}
  • {"files"=>["https://ndownloader.figshare.com/files/565894"], "description"=>"<p>Reductions in PHQ-9, GAD-7 and WASAS are each shown in a different pane. Comparisons between the reductions in the FTF and OTT groups shown by paired bars; OTT is always the upper and FTF the lower. These are presented first for the overall sample (adjusted and unadjusted; the first, naïve approach to analysis), then for the five propensity strata, and last for the 1∶1 matching procedure. Other than the first, unadjusted reductions, all average reductions (in the strata comparisons and in the 1∶1 matching) are adjusted for service provider, number sessions administered, and baseline symptom severity for the particular measure (PHQ9, GAD7 or WSAS). See: <a href=\"http://www.psychiatry.cam.ac.uk/wp-content/uploads/2012/08/PONE-D-11-20688-Figures.doc\" target=\"_blank\">http://www.psychiatry.cam.ac.uk/wp-content/uploads/2012/08/PONE-D-11-20688-Figures.doc</a> for colour version.</p>", "links"=>[], "tags"=>["reductions", "gad-7", "wsas", "scores", "ftf", "ott"], "article_id"=>236379, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.g002", "stats"=>{"downloads"=>2, "page_views"=>74, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Average_reductions_in_PHQ_9_GAD_7_and_WSAS_scores_for_FTF_versus_OTT_therapy_groups_/236379", "title"=>"Average reductions in PHQ-9, GAD-7 and WSAS scores for FTF versus OTT therapy groups.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 22:22:08"}
  • {"files"=>["https://ndownloader.figshare.com/files/566058"], "description"=>"<p>To assess non-inferiority between the treatments we used two-sided significance tests and 95% confidence intervals for score differences between treatment groups. The first pane is a key to the other six that show the results for the five strata (analysis approach 2) and for the 1∶1 matched sample (approach 3). The lower limit of the confidence interval (LCL) represents a boundary of non-inferiority. For all three measures, the LCLs were compared with two estimates of statistical uncertainty: small (0.2x pooled SD; inner vertical line closer to line of equivalence) and medium (0.5x pooled SD; outer line). The next six panes display adjusted mean differences in score reduction between OTT and FTF treatment assessing non-inferiority. In strata one to three, the lower confidence limit (LCL) of the adjusted mean difference fell below 0.2 SD on none of the measures, indicating strong evidence that neither treatment was inferior to the other. In stratum four and in the 1∶1 propensity matching, the WSAS LCL exceeded the 0.2 SD threshold, indicating only marginal support for non-inferiority regarding work and social adjustment improvement. The situation was different in stratum five, the group with most highest symptom scores, where the LCL exceeded 0.2 and 0.5 SD for the PHQ-9 and GAD-7 scores and 0.2 SD for the WSAS. This indicates potentially superior symptom reduction in all domains for individuals receiving FTF CBT. The <i>a priori</i> minimally important difference (MID) estimate of 5 points on the PHQ-9 is represented by the extreme limits of the x-axis in <a href=\"http://www.plosone.org/article/info:doi/10.1371/journal.pone.0042916#pone-0042916-g003\" target=\"_blank\">Figure 3</a> (−5 favouring FTF and +5 favouring OTT). No estimates or LCL approached this MID estimate. Furthermore, the effect size is small for all the potential differences, including those reaching statistical significance in strata 2 and 3. See: <a href=\"http://www.psychiatry.cam.ac.uk/wp-content/uploads/2012/08/PONE-D-11-20688-Figures.doc\" target=\"_blank\">http://www.psychiatry.cam.ac.uk/wp-content/uploads/2012/08/PONE-D-11-20688-Figures.doc</a> for colour version.</p>", "links"=>[], "tags"=>["differences", "gad-7", "wsas", "measures", "shown"], "article_id"=>236541, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.g003", "stats"=>{"downloads"=>6, "page_views"=>70, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Adjusted_mean_differences_in_PHQ_9_GAD_7_amp_WSAS_measures_shown_as_effect_sizes_/236541", "title"=>"Adjusted mean differences in PHQ-9, GAD-7 & WSAS measures shown as effect sizes.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-19 22:22:59"}
  • {"files"=>["https://ndownloader.figshare.com/files/566216"], "description"=>"<p>Cost per session for over-the-telephone (OTT) and face-to-face (FTF) therapies in IAPT during 2009–2010.</p>", "links"=>[], "tags"=>["over-the-telephone", "face-to-face", "therapies", "iapt"], "article_id"=>236702, "categories"=>["Medicine", "Mental Health", "Biotechnology"], "users"=>["Geoffrey C. Hammond", "Tim J. Croudace", "Muralikrishnan Radhakrishnan", "Louise Lafortune", "Alison Watson", "Fiona McMillan-Shields", "Peter B. Jones"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0042916.t005", "stats"=>{"downloads"=>5, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cost_per_session_for_over_the_telephone_OTT_and_face_to_face_FTF_therapies_in_IAPT_during_2009_8211_2010_/236702", "title"=>"Cost per session for over-the-telephone (OTT) and face-to-face (FTF) therapies in IAPT during 2009–2010.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-19 22:23:50"}

PMC Usage Stats | Further Information

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Relative Metric

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