Investigating the impact of providing a cognitive behavioural therapy intervention for frequent attenders at the Emergency Department with medically unexplained symptoms: A mixed method study

Abstract

AbstractBackgroundThere are a cohort of people who attend the Emergency Department (ED) extremely frequently. In many cases the symptoms driving their presentations are medically unexplained (MUS). ObjectivesThe aim of the research was to identify if providing a CBT intervention to frequently attending (high risk) patients with MUS in the healthcare setting they are comfortable with (ED) had impacted attendance patterns and if so how?DesignA mixed method approach was utilised to investigate the impact of providing CBT to ‘high risk’ group of frequent attenders with Medically Unexplained Symptoms at the Emergency Department. Quantitative participants were an opportunistic sample consisting of 50 of the most frequently attending (high risk) patients at the Emergency Department allocated to either control or intervention group. The qualitative research design employed semi-structured interviews. Ten participants were recruited from patients who had attended the CBT intervention. Interviews were transcribed verbatim and analysed using Thematic Analysis.ResultsThe patients who received the CBT intervention had significantly (p=0.001) reduced their ED attendances and inpatient bed days (p=0.001) following the intervention. In addition, the qualitative approach identified four meaningful themes through thematic analysis: The ED and Me; Psychological Impact; My Treatment and The Long-term Impact: What’s Changed?ConclusionThis study has given a detailed insight into the patients’ perspectives that supports the statistical data of their behaviour pre and post intervention. This study supported the declaration that providing a CBT intervention to high risk frequent attenders with MUS in the ED has a measurable impact on their health care utilisation, not only in the ED, but across the hospital.