Appendix C. Detail on criteria for audit of the use of CCBT for depression and anxiety

Possible objectives for an audit

An audit could be carried out to ensure the appropriateness of use of CCBT for depression and anxiety.

Possible patients to be included in the audit

An audit could be carried out on all people seen for depression or anxiety or OCD over a reasonable period for audit, for example 3 to 6 months. For this purpose, anxiety includes panic disorder, with or without agoraphobia, and generalised anxiety disorder.

Measures that could be used as a basis for an audit

The measures that could be used in an audit of CCBT are as follows.

Criterion

Standard

Exception

Definition of terms

1. A person with mild or moderate depression is offered Beating the Blues as an option for the management of the condition as outlined in the current NICE clinical guideline for the stepped-care management of depression in primary and secondary care

100% of people seen with mild or moderate depression

None

Clinicians will need to agree locally on how the offer of the option of management with CCBT is documented, for audit purposes.

See the NICE clinical guideline for the management of depression for a description of the stepped-care approach.

2. A person with depression is offered the option of management with CCBT with COPE or Overcoming Depression only as part of an ongoing or new clinical trial

100% of people with depression who are offered CCBT with COPE or Overcoming Depression

None

Clinicians will need to agree locally on how the offer of the option of management with CCBT is documented, for audit purposes.

A clinical trial is designed to generate robust and relevant data on the clinical effectiveness of these specific CCBT packages.

3. An adult with panic or phobia is offered FearFighter as an option for the management of the condition as outlined in the current NICE clinical guideline for the stepped-care management of anxiety

100% of people seen with panic or phobia

None

Clinicians will need to agree locally on how the offer of the option of management with CCBT is documented, for audit purposes.

See the NICE clinical guideline for the management of anxiety for a description of the stepped-care approach.

4. A person with OCD is offered CCBT with OCFighter

0% of people with OCD

The person is currently using OCFighter as routine therapy or as part of a clinical trial and such therapy should have the option to continue until the person, or the GP and/or specialist consider it appropriate to stop

'OCD' means obsessive-compulsive disorder. OCFighter was previously known as BTSteps. Clinicians will need to agree locally on how the decision to continue management with OCFighter is documented, for audit purposes.

A clinical trial is designed to generate robust and relevant data on the clinical effectiveness of this specific CCBT package.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.