A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland.

BACKGROUND: NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. METHODS: A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. RESULTS: Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. CONCLUSIONS: Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.

Benzodiazepine and z-hypnotic prescribing from acute psychiatric inpatient discharge to long-term care in the community.

BACKGROUND: Benzodiazepine and z-hypnotic prescribing has slowly decreased over the past 20 years, however long-term chronic prescribing still occurs and is at odds with prescribing guidance. OBJECTIVES: To identify the pattern of benzodiazepine and z-hypnotic prescribing in psychiatric inpatients at discharge and 12 months post-discharge. METHODS: Retrospective observational longitudinal cohort study of patients admitted to two adult psychiatric wards between June and November 2012 (inclusive) who were discharged with a prescription for a benzodiazepine or z-hypnotic drug. Routinely collected prescription data available from NHS Scotland Prescribing Information System was used to identify and follow community prescribing of benzodiazepine and z-hypnotics for a 12 month period post-discharge. Data were entered in Excel® and further analysed using SPSS 23. Ethical approval was not required for this service evaluation however Caldicott Guardian approval was sought and granted. RESULTS: Eighty patients were admitted during the study period however only those patients with a single admission were included for analysis (n=74). Thirty per cent (22/74) of patients were prescribed a benzodiazepine or z-hypnotics at discharge; 14 of whom received 'long-term' benzodiazepine and z-hypnotics i.e. continued use over the 12 month period. Seven patients received a combination of anxiolytics and hypnotics (e.g., diazepam plus temazepam or zopiclone). Long-term use was associated with a non-significant increase in median benzodiazepine or z-hypnotic dose, expressed as diazepam equivalents. CONCLUSIONS: One in three patients were prescribed a benzodiazepine or z-hypnotics at discharge with 1 in 5 receiving continuous long-term treatment (prescriptions) for 12 months post-discharge. As chronic long-term B-Z prescribing and use still remains an issue, future strategies using routine patient-level prescribing data may support prescribers to review and minimise inappropriate long-term prescribing.

A national survey of the infrastructure and IT policies required to deliver computerised cognitive behavioural therapy in the English NHS.

OBJECTIVE: This study aimed to identify if patients have adequate access to Computerised Cognitive Behavioural Therapy (cCBT) programmes in all mental health trusts across England. DESIGN: The primary researcher contacted a targeted sample of information technology (IT) leads in each mental health trust in England to complete the survey. SETTING: Telephone, email and postal mail were used to contact an IT lead or nominated expert from each mental health trust. PARTICIPANTS: 48 of the 56 IT experts from each mental health trust in England responded. The experts who were chosen had sufficient knowledge of the infrastructure, technology, policies and regulations to answer all survey questions. RESULTS: 77% of trusts provided computers for direct patient use, with computers in all except one trust meeting the specifications to access cCBT. However, 24% of trusts acknowledged that the number of computers provided was insufficient to provide a trust-wide service. 71% stated that the bandwidth available was adequate to provide access to cCBT sites, yet for many trusts, internet speed was identified as unpredictable and variable between locations. IT policies in only 56% of the trusts allowed National Health Service (NHS) staff to directly support patients as they complete cCBT courses via emails to the patients' personal email account. Only 37% allowed support via internet video calls, and only 9% allowed support via instant messaging services. CONCLUSIONS: Patient access to cCBT in English NHS mental health trusts is limited by the inadequate number of computers provided to patients, unpredictable bandwidth speed and inconsistent IT policies, which restrict patients from receiving the support needed to maximise the success of this therapy. English NHS mental health trusts need to alter IT policy and improve resources to reduce the waiting time for psychological resources required for patients seeking this evidence-based therapy.