Introduction and objectives Health outcomes for patients with respiratory conditions can be significantly affected by their psychological wellbeing; those experiencing psychological difficulties are less able to manage symptoms, have a poorer quality of life, and have more frequent hospital admissions. National guidance recommends the need for the assessment and treatment of psychological difficulties secondary to respiratory disease, but implementation of this across services is inconsistent. Here, we report the findings of a nine-month trial integrating clinical psychology into a specialist respiratory department, which aimed to identify the psychological needs within this patient group, provide interventions to address these needs, and to evaluate the impact of this across a range of outcome domains.
Methods Standardised measures were used at two timepoints to assess levels of common psychological difficulties among inpatients. Psychological assessment and intervention was implemented as clinically appropriate within the context of the wider multidisciplinary team. This addressed issues including breathlessness-related panic and anxiety, low mood, health concerns, self-management of illness, coping strategies, and supporting discharge. Data on hospital admissions were used to evaluate changes in healthcare use following intervention. Feedback was collected from both patients and staff to review the experience and acceptability of psychology provision.
Results Results showed that the rates of clinically significant symptoms of depression, anxiety, and health anxiety among inpatients were 71%, 40%, and 21% respectively. They highlighted that integrating clinical psychology into the multidisciplinary team was received well by patients and staff, leading to improved patient experiences and clinical outcomes, and a greater focus on holistic care. Of the 69 patients receiving psychology input with at least one month follow-up data, 77% showed a reduction in their admission frequency, and those readmitted showed an average reduction in length of stay of 1.7 days. The associated cost savings to the wider NHS more than covered the costs of providing psychology input.
Conclusions In light of existing literature, national guidance, and the present findings, we highlight the need for those commissioning and managing respiratory services to consider the varied benefits of integrating psychological provision for a patient group with high levels of psychological need.