Using patient-led appointment scheduling to improve cost-effectiveness, access, and patient satisfaction in NHS Talking Therapies services: A feasibility study

Research question

Is it feasible to conduct a trial comparing the effects of low-intensity psychological interventions for depression/anxiety delivered using either patient-led appointment scheduling (PLAS) or conventional appointment scheduling on clinical outcomes, patient access and satisfaction, and cost-effectiveness?

Background

Depression and anxiety are major causes of disability worldwide and are associated with lower quality of life and increased risk of suicide. NHS Talking Therapies offer low-intensity psychological therapies for anxiety and depression. Many groups, however, experience barriers to accessing these services (e.g., ethnic minority groups).

Inflexible and impersonal approaches to service delivery appear to contribute to inequitable access. Conventional approaches to appointment scheduling fail to account for individual differences that impact session attendance. PLAS is designed to give patients control over key parameters of appointment scheduling, including the overall numbers and frequency of sessions attended.

Compared to conventional appointment scheduling, PLAS could increase access (particularly for marginalised groups), patient satisfaction, and cost-effectiveness. Aims and objectives

Ultimately, we aim to conduct an evaluation trial that determines whether low-intensity psychological interventions delivered according to the principles of PLAS lead to improvements in cost-effectiveness, patient satisfaction, and access compared to current appointment scheduling approaches; and at least as good clinical outcomes (depression/anxiety). We first aim to determine the feasibility of: recruiting and retaining participants to inform a larger trial; and collecting clinical, health economic, and patient satisfaction data.

We will develop a suitable PLAS pathway, evaluate its acceptability amongst key stakeholders, and refine the approach prior to further testing and implementation. Methods

The study comprises four work packages (WPs). WP1: Up to six workshops with key stakeholders (patients, staff, managers) to identify and address barriers to implementing PLAS within NHS Talking Therapies. Results will help refine the PLAS pathway ready for testing in WP2.

WP2: Feasibility randomised controlled trial with 90 NHS Talking Therapies patients randomised 1:2 to either (i) treatment as usual or (ii) treatment as usual delivered using PLAS. We will collect patient data (including clinical, patient satisfaction, and health economic data) at baseline, six months, and nine months post-randomisation. WP3: Qualitative study using interviews and focus groups to explore the acceptability of PLAS amongst key stakeholders (patients, staff, senior NHS leadership).

WP4: Two world Café workshops with key stakeholders to interpret and integrate the findings of WP2 and WP3, and problem solve any outstanding issues that might impede further testing and the implementation of PLAS in NHS Talking Therapies. Timelines for delivery 30 months. Anticipated impact and dissemination

We aim to develop a PLAS pathway for NHS Talking Therapies that improves access, patient satisfaction, and cost-effectiveness, while ensuring clinical outcomes are at least as favourable as with conventional appointment scheduling. This study will help us understand the feasibility and acceptability of PLAS and optimise the approach so that it is ready for testing in a larger evaluation trial that evaluates the effectiveness of PLAS.