CBT to reduce healthcare use for medically unexplained symptoms: systematic review and meta-analysis (2019) Jones, Williams

J

JohnTheJack

Senior Member (Voting Rights)
Conclusion Cognitive behavioural interventions show weak benefits in reducing healthcare use in people with MUS. The imprecise use of MUS as a diagnostic label may impact on the effectiveness of interventions, and it is likely that the diversity and complexity of these difficulties may necessitate a more targeted approach.
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https://bjgp.org/content/69/681/e262.short
 
"Results Small reductions in healthcare contacts and medication use were found for CBT compared with active controls, treatment as usual, and waiting list controls, but not for medical investigations or healthcare costs."

Overall, if I understand correctly it doesn't sound like costs were reduced at all. "Small reductions in healthcare contacts" - less visits to see one's doctor, physio, etc.?

However, no reduction in "medical investigations or healthcare costs."

It would be instructive to see how people traveled through these programs. Were they very quickly bounced over to CBT after a MUS diagnosis, and ultimately had to go back and request actual biomedical help? Sounds like that may be exactly what happened.

Adding CBT on top of what is actually needed - biomedical care, adds to healthcare costs, and delays effective treatment.

Which has other spinoff problems - job and income loss, stigma, the potential for health to worsen...
 
How much has been wasted on IAPT already? £1B?

I know it's not just CBT but the "evidence base" for it is largely built on CBT trials like PACE and its economic analysis. It showed so much promise. Unless you actually looked at the evidence, of course. Like PACE's own economic analysis that was spurious and made many unrealistic assumptions.

So despite there predictably being no actual savings, sunk costs will likely mean a lot more additional wasted funding for a while. But it's worth it for no benefits at all, I guess. Maybe by doubling down there will be twice as many non-savings.

On top of the numerous disease-specific attempts at using CBT in various diseases that all fail like clockwork.

Ooops. Turns out betting billions on a massive top-down reform of health care on a pipe dream leads to a very rough hangover. Who could have predicted this except anyone with more than 12 functioning neurons?
 
Unfortunately, decision makers seem convinced that a large percentage of the public is delusional, or a reasonable facsimile.

Why otherwise would they have patients routinely shunted over to CBT after an initial misdiagnosis of MUS?


"Misdiagnosis on a grand scale?" outlines the significant problem of misdiagnosis. Referrals were examined for two "cfs" clinics: 40% were eventually re-diagnosed without "cfs" - many had other biomedical issues. In the second study 54% of people diagnosed with "cfs" had other health issues; mainly biomedcial:

http://www.meresearch.org.uk/information/publications/misdiagnosis-on-a-grand-scale/

ETA: When will authorities learn that allowing MUS diagnoses on a grand scale, costs more in healthcare funds?
 
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DokaGirl said:
Unfortunately, decision makers seem convinced that a large percentage of the public is delusional, or a reasonable facsimile.

Why otherwise would they have patients routinely shunted over to CBT after an initial misdiagnosis of MUS?


"Misdiagnosis on a grand scale?" outlines the significant problem of misdiagnosis. Referrals were examined for two "cfs" clinics: 40% were eventually re-diagnosed without "cfs" - many had other biomedical issues. In the second study 54% of people diagnosed with "cfs" had other health issues; mainly biomedcial:

http://www.meresearch.org.uk/information/publications/misdiagnosis-on-a-grand-scale/

ETA: When will authorities learn that allowing MUS diagnoses on a grand scale, costs more in healthcare funds?
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These numbers there are a bit debatable. 'Referred to a clinic' means a referral for assessment, I think, not reassessing someone who's already been diagnosed.

So 40% not having ME could be actually positive--it means they're not just diagnosing everyone but are presumably doing exclusionary diagnosis too.

It's sensible that not everyone who gets referred gets diagnosed.
 
rvallee said:
How much has been wasted on IAPT already? £1B?
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from CBT watch Nov 3
National Audit Office Failed To Audit Improving Access To Psychological Therapies Service

Dr Scott comments that the reasons that prompted the investigation still remain. He adds that the IAPT service has cost the taxpayer over £3 billion in the last decade with no independent audit of outcome. Clinical Commissioning Groups have simply taken at face value IAPT’s marking of its’ own homework – whither accountability?
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In his submission to the NAO Dr Scott pointed out that IAPT had never been subjected to independent audit using the ‘gold standard’ methodology that has been used to assess the effectiveness of a drug. His own published research see link https://journals.sagepub.com/doi/10.1177/1359105318755264 has suggested that only the tip of the iceberg of IAPT client’s recover much less than the 50% claimed by the Organisation
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http://www.cbtwatch.com/national-au...ng-access-to-psychological-therapies-service/
 
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adambeyoncelowe said:
These numbers there are a bit debatable. 'Referred to a clinic' means a referral for assessment, I think, not reassessing someone who's already been diagnosed.

So 40% not having ME could be actually positive--it means they're not just diagnosing everyone but are presumably doing exclusionary diagnosis too.

It's sensible that not everyone who gets referred gets diagnosed.
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@adambeyoncelowe I agree - it's good not everyone, once at the ME clinics in question are being diagnosed with ME.

One of the big problems in this whole situation is waiting times without treatment.

The GPs doing the initial referrals must have had some idea these patients had ME, and sent them along to the specialty clinics. These GPs missed the correct diagnoses, many of which noted in the article are serious.

The patients had to wait for whatever time it took to consult at the clinic, go through whatever investigations that entailed (if any), and eventually, maybe be diagnosed with something treatable. During the interim they had no treatment for their correct diagnosis. With a new diagnosis in hand, there would often be another wait to see the correct specialist. All in all, quite a bit of time elapsed without any treatment.

I don't know about wait times in the UK, but here they may be one to two years or more depending on factors.

ETA: changed the word "some" to "many"
 
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Sly Saint said:
from CBT watch Nov 3
National Audit Office Failed To Audit Improving Access To Psychological Therapies Service



http://www.cbtwatch.com/national-au...ng-access-to-psychological-therapies-service/
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Ouch. That's bad.

Bold move to take the same approach as the CBT-GET treatment model: don't bother checking. But the thing about not checking whether something works is that it's borrowed time when you waste this much money. When it comes to ME the losses are aggregate and hard to find. Here with direct expenditures at some point someone will actually check because they actually ate the onion and believed in the promised benefits.

Guaranteed this whole thing will have plenty of Icarus imagery. The fools tried flying too close to the sun with wings made of BS held together with guano.

Many of you probably only watched the UK version but in the US version of The Office, first episode I think, Michael makes this huge promise of a surprise that the entire office will be super happy about but because he's an idiot he can't even find anything to salvage his promise and only ends up bringing ice cream sandwiches. That's basically IAPT, or the CBT-GET paradigm, in a nutshell: promise something big and bold, deliver melted gas station ice cream sandwiches. At the low, low cost of billions.

Extraordinary promises with no ordinary evidence. It only fails every time so go for broke.
 
chrisb said:
Perhaps they should have relied on an accountant rather than an economist. But there again, perhaps not.
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A competent economist would have taken externalities and opportunity cost into account and understood that the benefits are an illusion when accounting for everything. An accountant would only have seen the accounted-for money and been more easily fooled.

They should have gone with competent economists or actuaries, but they probably did and disliked the answer so switched their outcomes in the hope that their imaginary benefits could be real. After all, it worked with PACE. Problem is they don't seem to understand that pushing a polished turd over the line is actually the starting point, not the end of the race. Once they meet reality, pipe dreams evaporate rather quickly.
 
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