Intended for healthcare professionals

General Practice

A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector

BMJ 2000; 320 doi: (Published 12 February 2000) Cite this as: BMJ 2000;320:419
  1. Clare Grant, clinical lecturer (clare.grant{at},
  2. Trudy Goodenough, research officerb,
  3. Ian Harvey, professor of epidemiology and public healthc,
  4. Chris Hine, consultant in public health medicineb
  1. a Division of Primary Health Care, University of Bristol, Bristol BS8 2PR
  2. b Avon Health Authority, King Square, Bristol BS2 8EE
  3. c School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  1. Correspondence to: C Grant
  • Accepted 11 November 1999


Objectives: To compare outcome and resource utilisation among patients referred to the Amalthea Project, a liaison organisation that facilitates contact between voluntary organisations and patients in primary care, with patients receiving routine general practitioner care.

Design: Randomised controlled trial with follow up at one and four months.

Setting: 26 general practices in Avon.

Participants: 161 patients identified by their general practitioner as having psychosocial problems.

Main outcome measures: Primary outcomes were psychological wellbeing (assessed with the hospital anxiety and depression scale) and social support (assessed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functional health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of prescribing in primary care, and cost of referrals to other agencies, over four months.

Results: The Amalthea group showed significantly greater improvements in anxiety (average difference between groups after adjustment for baseline −1.9, 95% confidence interval −3.0 to −0.7), other emotional feelings (average adjusted difference −0.5, −0.8 to −0.2), ability to carry out everyday activities (−0.5, −0.8 to −0.2), feelings about general health (−0.4, −0.7 to −0.1), and quality of life (−0.5, −0.9 to −0.1). No difference was detected in depression or perceived social support. The mean cost was significantly greater in the Amalthea arm than the general practitioner care arm (£153 v £133, P=0.025).

Conclusion: Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with usual general practitioner care in managing psychosocial problems, but at a higher cost.


  • Funding Avon Health Authority.

  • Competing interests None declared.

  • website extra The sample size calculation appears on the BMJ's website

  • Accepted 11 November 1999
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