Generalized access to psychotherapy upon GP referral in France: results from the pilot study
In France, despite clinical guidelines supporting psychotherapy as the main treatment for mild to moderate anxiety and depressive disorders, general practitioners (GPs) have long relied on psychotropic medications as first line treatment, in the absence of available reimbursed psychotherapies.
In 2018, the French Social Health Insurance organisation (CNAM) set up a large-scale pilot study to address this issue. General practitioners (GPs) from four French territories (départements) could refer patients with incident mild to moderately severe anxiety or depressive disorders, and no psychiatric comorbidity, to registered private-practice psychologists/psychotherapists, for an initial evaluation followed by up to 20 sessions of ten supportive and then ten structured psychotherapy (with mandatory advice from a psychiatrist) if needed. All sessions were funded by the CNAM and free of charge for the patient.
In order to assess the benefits of and fine-tune these new referral pathways, before a possible roll-out, a broad interdisciplinary evaluation framework was set up in 2019, relying on qualitative (interviews) and quantitative data (surveys and two cohorts), addressing the implementation (uptake, adaptation, acceptability), clinical benefits, and opportunity for roll-out (improvements, support, efficiency) of the pathway.
By 31 March 2022, 4,042 general practitioners and 947 psychologists and psychotherapists had been involved in the pathway; 37,841 patients had been enrolled, and had undergone 405,674 psychotherapy sessions in total. Patients in the pilot pathway received less antidepressant prescriptions, with clinical benefits that matched usual care. Large groups of GPs and psychologists/psychotherapists were supportive of the experimental pathway and asked for its roll-out, albeit with adjustments, notably regarding administrative burden, patient inclusion criteria, psychiatric advice and particularly the low tariff of psychotherapy sessions.
Overall, the evaluation supports the roll-out of the updated GP-pscyhologist/psychotherapist referral pathway that took place in April 2022, in the wake of the COVID-19 pandemic, and underlines remaining challenges.
In 2018, the French Social Health Insurance organisation (CNAM) set up a large-scale pilot study to address this issue. General practitioners (GPs) from four French territories (départements) could refer patients with incident mild to moderately severe anxiety or depressive disorders, and no psychiatric comorbidity, to registered private-practice psychologists/psychotherapists, for an initial evaluation followed by up to 20 sessions of ten supportive and then ten structured psychotherapy (with mandatory advice from a psychiatrist) if needed. All sessions were funded by the CNAM and free of charge for the patient.
In order to assess the benefits of and fine-tune these new referral pathways, before a possible roll-out, a broad interdisciplinary evaluation framework was set up in 2019, relying on qualitative (interviews) and quantitative data (surveys and two cohorts), addressing the implementation (uptake, adaptation, acceptability), clinical benefits, and opportunity for roll-out (improvements, support, efficiency) of the pathway.
By 31 March 2022, 4,042 general practitioners and 947 psychologists and psychotherapists had been involved in the pathway; 37,841 patients had been enrolled, and had undergone 405,674 psychotherapy sessions in total. Patients in the pilot pathway received less antidepressant prescriptions, with clinical benefits that matched usual care. Large groups of GPs and psychologists/psychotherapists were supportive of the experimental pathway and asked for its roll-out, albeit with adjustments, notably regarding administrative burden, patient inclusion criteria, psychiatric advice and particularly the low tariff of psychotherapy sessions.
Overall, the evaluation supports the roll-out of the updated GP-pscyhologist/psychotherapist referral pathway that took place in April 2022, in the wake of the COVID-19 pandemic, and underlines remaining challenges.