[Cooperation between primary care and mental health services]

Assessment of a Primary Support Program: family physicians and mental health professionals' perspective

BACKGROUND

Mental health (MH) disorders are increasingly prevalent in primary care (PC) and this has generated, in recent years, the development of strategies based on the collaborative model and the stepped care model. The Primary Support Program (PSP) was implemented in the community of Catalonia (Spain) during 2006 to improve, from the first level of care, treatment of the population with mild-moderate complexity MH problems along with identification and referral of severe cases to specialized care. The aim of the present study was to identify the strengths and limitations of the PSP from the perspective of health professionals involved in the programme.

METHODS

An explanatory qualitative study based on Grounded Theory. We conducted group semistructured interviews with 37 family physicians and 34 MH professionals. A constant comparative method of analysis was performed.

RESULTS

Operation of the PSP is influenced by internal factors, such as the programme framework, MH liaison, management of service supply and demand, and the professional team involved. Additionally, external factors which had an impact were related to the patient, the professionals, the Health System, and community resources.

CONCLUSIONS

The operation of the PSP could benefit from a review of the programme framework and optimization of MH liaison. Improvements are also proposed for MH training in PC, intraprofessional coordination, use of community resources, and creation of efficient continuous assessment systems.

[Gender inequality and mental health medicalization: Sociocultural determining factors from the analysis of expert perceptions]

To identify the sociocultural roots that explain the higher frequency of diagnoses of depression and/or anxiety and the prescription of psychotropic drugs in women, in order to propose a preliminary explanatory framework for the investigation of gender inequalities in mental health and its medicalization. Qualitative study with a descriptive-interpretive design, through in-depth interviews conducted in January and February 2021. Interviews were held in various cities of the Basque Country, Barcelona and Madrid. 12 experts in gender and mental health from the clinical (Primary Care and Mental Health), academic and associative fields. Intentional sampling, following the snowball technique, until covering the diversity of previously identified profiles and the saturation of the discourse. An analysis of thematic content was carried out starting from a critical-realistic epistemological perspective. The main dimensions to explain gender inequalities in diagnoses of depression or anxiety and prescription of psychoactive drugs were: 1) the material and symbolic subordination of women, 2) the role of «psi» sciences in the pathologization of the feminine identity, 3) the epistemological and androcentric biases of biomedicine, and 4) the active agency of women in medicalization processes. The reduction of gender inequalities in the diagnoses and prescription of psychotropic drugs will require joint intervention at the clinical, community and structural levels that, from a feminist perspective, manage to reverse the socioeconomic, symbolic and epistemic vulnerability of women.

Adolescência e saúde mental: a perspectiva de profissionais da Atenção Básica em Saúde

Considerando os apontamentos da literatura sobre a vulnerabilidade de adolescentes ao sofrimento psíquico e a escassez de achados que focalizem o cuidado a essa população, esta pesquisa visou identificar como tem ocorrido a atenção psicossocial de adolescentes em sofrimento psíquico segundo profissionais da Atenção Básica em Saúde (ABS). Trata-se de estudo qualitativo que teve a participação de 12 profissionais entrevistados por meio de um roteiro semiestruturado. Os dados, tratados pela Análise Temática de Conteúdo, apontaram fragilidades no acesso do adolescente aos serviços de ABS e, nos casos de sofrimento psíquico, a prática de encaminhamentos a serviços especializados. Observa-se o reconhecimento das profissionais sobre a pontualidade das ações em rede setorial/intersetorial. O estudo avança ao reforçar a necessidade da implementação do cuidado à saúde mental de adolescentes, que considerem a potência da ABS, sob a voz dos profissionais envolvidos.

Factors associated with visits to general practitioners in patients with schizophrenia in Malaga

Background

Patients with psychiatric disorders have more physical problems than other patients, so their follow-up by the general practitioner is particularly important for them.

Methods

We aimed to elaborate a multilevel explanatory model of general practitioner (GP) visits made by patients with schizophrenia and related disorders (SRD). An observational, cross-sectional study was conducted from January 1, 2008 to July 1, 2011, in the area of the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population consisted of all patients with SRD in contact with a GP residing in the study area. Our dependent variable was total number GP visits. The independent variables were: 1) patient variables (sociodemographic and clinical variables); 2) primary care centre (PCC) variables. We performed descriptive analysis, bivariate analysis and multilevel regression.

Results

Four hundred ninety four patients were included. Mean annual number of GP visits was 4.1. Female sex, living in a socioeconomically deprived area, a diagnosis of schizoaffective disorder and contact with a GP who had a more active approach to mental health issues were associated with a higher number of visits whilst being single and good communication between the PCC and mental health teams were associated with a lower number of GP visits.

Conclusions

Number of GP visits was not just associated with patient factors, but also with organisational and the involvement of health professionals, for example GPs with an active approach to mental health issues.

Electronic supplementary material

The online version of this article (10.1186/s12875-018-0866-7) contains supplementary material, which is available to authorized users.

[Primary care and mental health care collaboration in patients with depression: Evaluation of a pilot experience]

Objetivo

Implementar y evaluar una experiencia colaborativa entre Atención Primaria (AP) y Salud Mental (SM) para mejorar la asistencia a los pacientes con depresión.

Diseño

Proyecto colaborativo piloto con enfoque de investigación acción participativa (IAP) durante 2013.

Emplazamiento

: País Vasco. Osakidetza (Servicio Vasco de Salud). Bizkaia y Gipuzkoa.

Participantes

Doscientos siete profesionales de medicina de familia, enfermería, psiquiatría, enfermería psiquiátrica, psicología y trabajo social de 9 centros de salud y 6 centros de salud mental de Osakidetza.

Intervenciones

Diseño y desarrollo compartido de 4 ejes de intervención: 1) comunicación y conocimiento entre profesionales de AP y SM; 2) mejora en la codificación diagnóstica y derivación de pacientes; 3) formación compartida mediante sesiones y guías de práctica clínica comunes, y 4) evaluación.

Mediciones principales

Encuestas a profesionales de centros de intervención y control sobre conocimiento y satisfacción en la relación AP-SM, actividades formativas conjuntas y valoración de la experiencia. Registros de Osakidetza sobre prevalencias, derivaciones y tratamientos. Reuniones de seguimiento.

Resultados

Mejoría en los centros de intervención respecto a los de control en los 4 ejes de intervención. Identificación de factores a considerar en el desarrollo y la sostenibilidad de la colaboración AP-SM.

Conclusiones

La experiencia piloto confirma que los proyectos colaborativos promovidos por AP y SM pueden mejorar la asistencia y satisfacción de los profesionales. Son proyectos complejos que requieren intervenciones simultáneas adecuadas a las singularidades de los servicios de salud. La participación pluridisciplinaria y continuada, y el apoyo de la gestión y los sistemas de información, son condiciones necesarias para su implementación.

Preparedness of Lithuanian general practitioners to provide mental healthcare services: a cross-sectional survey

BACKGROUND

A large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners' (GPs) experience in mental healthcare and their perceptions about how to increase their involvement in the field.

METHODS

In this cross-sectional study, a 41-item questionnaire was distributed to a random sample of 797 Lithuanian GPs in order to investigate current practices in their provision of mental healthcare as well as their suggestions for the improvement of mental healthcare services in primary care.

RESULTS

The response rate was 52.2%. Three-quarters of the GPs agreed that they feel responsible for the management of mental health problems, but only 8.8% of them agreed that "My knowledge in mental healthcare is sufficient". Psychiatrists were identified as the mental healthcare team specialists with whom 32% of the respondents discuss the management of their patients with a mental disorder. Collaboration with psychologists and social workers was almost threefold lower (11.6% and 12.5%). Capacity-building of GPs was found to be among the most promising initiatives to improve mental health services in primary care. Other strategies mentioned were policy level and managerial measures as well as strengthening the teamwork approach in mental healthcare.

CONCLUSIONS

This study found a low self-reported competence of GPs in mental healthcare and low collaboration among GPs and other specialists in providing mental healthcare. For the situation to improve in the country, these findings point to a need for strategies to improve GPs' expertise and teamwork in mental healthcare.

Costs of depression in Catalonia (Spain)

OBJECTIVE

To estimate the cost of depression for the adult population in Catalonia (Spain) for 2006.

METHOD

The total adult population of Catalonia for the reference year was close to 6 million. A cross-design synthesis study was conducted, combining "top-down" and "bottom-up" data from secondary data sources, as well as expert opinion (nominal groups). A societal perspective was adopted. Estimates included direct health costs (hospital, primary, specialised and pharmacological care) and the indirect costs derived from the productivity lost due to morbidity and mortality. Sensitivity analyses were carried out for primary and specialised care resource utilisation. A Monte Carlo simulation model was developed to handle the uncertainty of the unit costs of primary care, specialised care and hospital visits.

RESULTS

The total annual cost of depression in Catalonia for 2006 was 735.4 million Euros. Of this figure, 21.2% corresponded to direct costs, including 41 million Euros in primary care (5.6%), 8.1 million Euros in mental health specialised care (1.1%), 5.6 million Euros due to hospitalisation (0.8%) and 101.1 million Euros due to pharmacological care (13.7%); and 78.8% to indirect costs due to productivity loss. 3.7 million work days were lost to temporary disability for depression with a cost of 199.6 million Euros (27.1%), and 353.3 million Euros due to permanent disability (48%). Mortality attributed to suicide accounted for 26.9 million Euros (3.7%). The average annual cost of an adult with depression was close to 1800 Euros.

LIMITATIONS

The heterogeneity of the data sources, the uncertainty in several estimates (i.e. proportion of psychotropic expenditure attributed to the treatment of depression, suicide rate attributed to depression), and the difficulty in disaggregating anxiety and depressive disorders in a number of databases are study limitations.

CONCLUSIONS

The burden of depression for the Catalan public health system and society as a whole due to the consumption of resources and, more importantly, the loss of productivity is significant. Inefficiencies may be found in the overuse of pharmaceuticals and in the eligibility criteria of disability for work.