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CBT by respiratory nurses can reduce anxiety in COPD patients

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Cognitive behavioural therapy intervention delivered by respiratory nurses can reduce anxiety symptoms in chronic obstructive pulmonary disease, according to UK researchers.

They found CBT delivered by respiratory nurses to be a “clinically and cost-effective treatment” for anxiety in patients with COPD when compared to self-help leaflets.

“A brief CBT intervention, uniquely delivered by respiratory nurses, was clinically effective”

Study authors

Based on their findings, the study authors recommended that CBT should be “incorporated into routine clinical care pathways”.

The researchers, led by nurse consultant Karen Heslop-Marshall, noted that anxiety and depression were major co-morbidities in COPD and associated with high morbidity, disability, healthcare expenditure and mortality.

They randomised 279 COPD patients to either CBT or self-help leaflets. Anxiety, depression and quality of life were measured at the start of the trial and then at three, six and 12 months.

The “brief” CBT sessions were conducted either in clinic or at home and lasted 30 minutes, noted the study authors from Newcastle upon Tyne Hospitals NHS Foundation Trust.

Newcastle upon Tyne Hospitals NHS Foundation Trust

Karen Heslop-Marshall

Karen Heslop-Marshall

Two of the nurses involved had completed a post-graduate diploma in CBT, while two more nurses had completed three days CBT training, said the researchers in the journal ERJ Open Research.

They used the Hospital Anxiety and Depression Anxiety Subscale (HADS), a brief self-completed questionnaire. Scores of 8-10 indicates mild symptoms, 11-14 moderate and 15-21 severe.

The mean HADS-Anxiety Subscale was 12.3 for the CBT group and 12.0 for the self-help leaflet group at baseline, suggesting moderate anxiety symptoms

However, the researchers found the mean change from baseline to three months was 3.4 for the CBT group and 1.88 in the leaflet group.

The researchers added that, importantly, the CBT intervention was more cost-effective than leaflets at 12 months, significantly lowering hospital admissions and attendance at emergency departments.

For example, patients randomised to CBT had fewer hospital admissions and fewer emergency department attendances – 0.6 versus 1.01 and 0.37 versus 1.01, respectively.

The study authors calculated that the CBT intervention initially cost £175 more per patient than the self-help leaflets.

“CBT should be incorporated into routine clinical care pathways”

Study authors

But this was “offset” by lower costs from hospital admissions and emergency attendances – a mean saving of £1,088 and £63 per patient, respectively, giving an overall difference of £977.

“While the CBT intervention incurred initial costs for training and supervision, these costs were offset by lower subsequent costs for respiratory admissions and emergency department attendances over 12 months,” they said.

In their conclusion, the authors stated: “This study shows that a brief CBT intervention, uniquely delivered by respiratory nurses, was clinically effective at reducing anxiety symptoms and was cost-effective.

“Costs were reduced by lower resource use with lower hospital admissions and a reduction in emergency department attendances,” they stated.

They added: “Respiratory nurses with dual respiratory and CBT skills can address common co-morbid symptoms of anxiety that were previously under treated. CBT should be incorporated into routine clinical care pathways.”

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