A register-based study of long-term healthcare use before and after psychotherapy

Abstract

Background: Psychotherapeutic treatment for non-psychotic disorders is associated with significant reduction in patients’ symptoms, and therefore it is believed that treatment improves health and decreases the need for additional healthcare. However, little is known about long-term changes in utilization of healthcare services. Aim: To investigate long-term changes in utilization of public healthcare services for patients referred to psychotherapeutic treatment. Methods: A pre–post study with 761 consecutive patients and 15,220 matched individuals in a matched population reference group. Data from a comprehensive set of healthcare services were collected from central registries for 4 years prior to intake and for 4 years after completion of treatment. Results: Of the 761 patients, 216 did not show up for treatment and 545 completed treatment. Completer patients achieved a substantial reduction in symptoms (effect size, ES = 0.99). However, completer patients increased their use of all healthcare services by 296% (ES = 0.58) in the 4th year pre–post comparison, while the reference group increased usage by 99% (ES = 0.23). Completer patients had significantly higher increase in contacts with psychiatric hospitals (P < 0.008), contacts with primary care psychologists (P < 0.001), psychotropic medication (P < 0.001) and contacts with primary care physicians (P < 0.001) than the reference group at the 4th year pre–post comparison. Conclusion: Over a long-term period, patients who completed psychotherapeutic treatment increased utilization of healthcare services. Studies are needed to clarify how and why psychotherapeutic treatment does not necessarily lead to a reduction in the utilization of healthcare services for the average patient and to evaluate other potential interventions for patients with mental problems and include efficiency studies in this evaluation.

• Health services
• Mental disorders
• Psychotherapy
• Registries
• Utilization

Acknowledgement

The study was sponsored by TrygFonden as part of the research project “Outcome in psychotherapeutic treatment”.

Declaration of interest: None of the authors (M. Fenger, E.L. Mortensen, S. Poulsen or M. Lau) has any financial or other relationship in general or relevant to the subject of this article. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.