Dr Grant Blashki1, Professor Leon Piterman2, Professor Graham Meadows3, Associate Professor David Clarke3, Professor Jane Gunn1, Professor Fiona Judd1,4
1 Department of General Practice, The University of Melbourne.
2 School of Primary Health Care and Deputy Dean of the Faculty of Medicine, Nursing and Health Sciences, Monash University
3 School of Psychology, Psychiatry and Psychological Medicine, Monash University.
4 Centre for Rural Mental Health Bendigo; and, on behalf of the PEP Advisory Group
beyondblue Victorian Centre of Excellence
Project completion year
The aim of the study was to evaluate the impact of GP training in Cognitive Behavioural Therapy (CBT) Skills using a randomised controlled design. Specifically, our objectives were to examine whether general practitioners who completed training in CBT strategies demonstrate:
- an increased knowledge of CBT
- an increase in confidence in delivering CBT in general practice
- an improvement in the quality of CBT they delivery in simulated role plays
- improved clinical outcomes for patients (recovery rate from depressive disorder)
- improvements in consumer satisfaction with GP psychological care.
Main outcomes / key project findings
The implications of this study have relevance to primary care researchers, GP educators and policy makers. There are valuable lessons for researchers venturing into primary care, and we make the following suggestions:
- GPs who undertook CBT training demonstrated an improvement in knowledge of CBT techniques (mean improvement 1.52, [0.66-2.4] p=0.0004 ).
- GPs who undertook CBT training demonstrated increased confidence in providing CBT to treat depression (percentage of GPs who described themselves as moderately or very confident increased from 17.4 per cent pre-training to 85.1 per cent post-training), and increased confidence in specific CBT skills: Structured Problem Solving (41.7 per cent pre-training to 100 per cent post-training); Activity Planning (50 per cent pre-training to 100 per cent post-training); Sleep Wake Cycle Management (52 per cent pre-training to 100 per cent post-training); and Cognitive Therapy (16.7 per cent pre-training to 89.6 per cent post-training).
- GPs who undertook training in CBT demonstrated improvements in CBT skills as measured using standardised simulated patient consultations that were videotaped and rated by two expert raters, blinded as to whether GPs were in control or intervention groups.
- GP recruitment requires active personal engagement with GPs, especially by visiting their practices, financial incentives, simple study protocols, and a clear expectation of the benefits to patients and their clinical care.
- Where possible avoid asking GPs to recruit patients or if the study absolutely requires this, we suggest employing on site research assistants at the practice to do so.
- Video taping simulated consultations in GP surgeries is a powerful and acceptable methodology for assessing GP skill acquisition.
Implications for policy and practice
Implications for GP training in psychological skills include the following recommendations:
Emphasis should be given to helping GPs to provide an explicit explanation of their psychological approach to patients before embarking on care.
GPs training in psychological treatments should include skills in assessing patient suitability for GP-provided care versus specialist psychological care, and collaboration should be emphasised.
GPs that are providing specific psychological treatments need further training, peer support and/or supervision beyond the standard 20 hours training, if skills acquired are to be incorporated into routine actual practice.
For policy makers, the implications of the PEP study are that in general, it supports the current policy approach with GPs being encouraged to work collaboratively with mental health specialists. At the same time, it suggests that if GPs are to effectively deliver specific psychological treatments, more training, professional support and supervision are necessary.
The PEP Study has already provided a platform for successful funding applications to The Australian Primary Health Care Research Institute (The “Optimizing Primary Mental Health Care Workforce” Review). PHCRED (A four year fellowship in Primary Care Psychological Treatments) and beyondblue’s Victorian Centre of Excellence in Depression and Related Disorders (The SIM Study – reducing suicide in men through general practice).
The PEP Study data will be compared with the data in the diamond study which is currently underway, and will be used to inform our APHCRI funded systematic review.