Now this survey was undertaken to obtain better insight into how practice in mental health is distributed among medical professionals in a French area, prior to reorganisation of mental health services. To our knowledge no other survey is addressed exhaustively to all physicians involved in mental health care in a particular geographical area. In a pilot area, prior to a reorganization of mental health care, a survey was conducted among local physicians involved in mental health care. So aim was to gain a better understanding of the overall organization of mental health care. General Practitioners’ opinions on their practice in mental health and their collaboration with mental health professionals were studied.
In France up till now patients were free to consult GPs, psychiatrists in private practice in the community or psychiatrists working in the public sector. There were 60 815 GPs in France in 1996, and 11 816 PrPs and PuPs in 1997. And therefore the chisquare test was used for categorical variables and ANOVA tests for continuous variables, as appropriate. Three groups were considered. That’s right! GPs, PrPs and PuPs. That’s interesting right? Descriptive and comparative analyses were carried out on physician demographics, patient profiles, mental health practice and job satisfaction. Analyses were performed with SAS 2 Software. On top of that, except for scope for finding replacements and administrative paperwork, gPs, PrPs and PuPs did not differ in accordance with their general practice satisfaction.
Mental health practice seemed a burden to all professionals. Physicians, and especially psychiatrists, were overworked and had difficulty providing the care they considered suitable. GPs, PrPs and PuPs however differed as indicated by their mental health practice satisfaction. Psychiatrists experienced more difficulties in taking on new patients because of workload, and in entrusting part of their care to another professional than did GPs. That said, satisfaction with mental health practice was low for all three physicians categories. It’s a well timelapse between consultations was longest for GPs, intermediate for PuPs and shortest for PrPs. Access to care had been delayed longer for Psychiatrists than for GPs. GPs had fewer patients with long standing psychiatric disorders than PrPs and PuPs. I’m sure it sounds familiar. GPs and PrPs were very similar but very different from PuPs for the proportion of patients with anxious or depressive disorders, psychotic disorders, previous psychiatric hospitalization.
While reflecting differing interest for the mental health program conforming to the professional group, the first limitation is the moderate response rate.
Even if they are interested in mental health care, as first line professionals, gPs in France are contacted by numerous care networks which could take up plenty of their time.
Among psychiatrists, public psychiatrists seemed more concerned than private psychiatrists possibly as long as they are more concerned about public health problems. Second, GPs may present an interest variable. Generally, gPs may feel less concerned than psychiatrists for different reasons. They have been also asked to give the overall number of consultations throughout the same period. GPs, representing 15 dot 0 of the overall number of consultations. Whenever distinguishing between new patients and those already in ‘followup’, gPs were asked to include prospectively over a 8day period all consulting patients important result of the survey lies to the unequal access to mental health care for patients in the light of the first professional consulted.
It can be supposed that the first professional consulted is determined by social and educational levels.
GP, PrP or PuP. PrPs tended to see their patients more often than did GPs. For instance, patients with mental health problems seemed fairly similar between primary care and private psychiatric settings. Whatever the professional category of the practitioner first consulted, these professionals catered for their patients on their own. Thus, the care provided was different. Respondent physicians were predominantly experienced providers, male and between 36 and 54 years old. I’m sure you heard about this. More minor activities were paper work, further education and exchanges with colleagues.
Professional activity consisted mostly in clinical activity. PuPs were on average younger than the others. Then the survey did not intend to assess the prevalence of psychiatric disorders in practice, or needs for mental health treatment, already studied. Therefore this means of assessment could involve a recruitment bias with a selection of particular patients. Normally, the second limitation is that the results are on the basis of reports from the professionals, and particularly in the case of GPs, on their reporting of mental health patients that they themselves identified as having mental health problems. Private professionals complained about administrative demands. All physicians complained about insufficient time for further education and above all, for writing medical articles and for research. In France, litigation is still relatively rare. Yes, that’s right! Time pressure and paperwork have already been shown as frequently reported factors in stress and job dissatisfaction among Australian GPs, insufficient participation in research was reported among Canadian psychiatrists and finally, administrative demands were noted among Australian psychiatrists. Nevertheless, insufficient time for further education is confirmed by results on time allocation. Now let me tell you something. Then the present survey did not study litigation and compensation problems, shown to be the most frequent reason for dissatisfaction for private psychiatrists in previous studies in other countries.
Accordingly the main apportionment of waking time is roughly similar when compared with previous studies. By the way, the results on job satisfaction among these professionals has revealed a moderate to poor degree of satisfaction. Providing care for mental health problems concerns General Practitioners, Private Psychiatrists and Public Psychiatrists. Besides, in developed countries, mental health problems, especially anxious and depressive disorders, are frequent and a leading cause of disability in regards to cost to the individual and society. Also, psychotics patients were a lot more numerous and anxious or depressed patients much less numerous among PuP patients than among community physician patients. GPs and PrPs were very similar for percentages of patients diagnosed as anxious or depressed and for percentages of psychotic patients. Known mental Health care concerns the entire health system. Although, of all, there’re general practitioners who play a pivotal role, as first line and as the main health professional consulted. For patients already known to the practitioners, timelapse between consultations was the longest for GPs, intermediate for PuPs and the shortest for PrPs.
Among psychiatrists, different patterns of care were noted. Collaboration with another professional less often occurred for community physician patients than for PuP patients. PuPs had patients with more severe characteristics for these variables than GPs and PrPs. Notice that gP and PrP patient percentages did not differ for previous psychiatric hospitalization and national disability allowance. Drafting of the manuscript. Statistical expertise. However, critical revision. Study concept and design. Younès. Gasquet, Kovess, Hardy Bayle. Have you heard of something like this before? Younès. Oftentimes analysis and interpretation. Acquisition of data, study supervision. Eventually. Younès. So this article is published under license to BioMed Central Ltd. While a quarter of psychiatrists’ patients were referred by GPs, gPs had no patients referred by another physician. Patient recruitment differed. GPs had fewer new patients for whom they considered that access to mental health care had occurred late. Besides, the proportion of new patients among consultants was the highest for GPs, intermediate for PuPs and the lowest for PrPs. I know that the 492 GPs, the 82 PrPs and the 75 PuPs in the position of South Yvelines were approached by post in spring 2000 and informed of the local mental health program.
With a postagepaid reply envelope if they agreed to participate, they’ve been asked if they have been willing to recruit for the survey. GPs, 45 PrPs and 63 PuPs were included. So this result evidencing poor relationships among physicians is important since infrequent and unsatisfactory links between primary care and specialist health care are a reason for concern in a couple of countries. It raises that issue of they have been particularly dissatisfied with their relationships with PrPs, possibly being that they felt closer to them so that they may have more expectations in regards to relationships and collaboration with them. GPs desired some sort of collaboration for their new patients far more frequently than PrPs. Nevertheless, who, gPs manage patients with severe mental health problems but see their patients less often than do PrPs, expressed dissatisfaction with their relationships with psychiatrists. Survey showed another aspect that is important for the efficiency of that care system. Therefore, physicians’ ability to obtain outpatient and inpatient services they required had been shown to be the most consistent and powerful predictor of changes in levels of practice satisfaction over time in a American nationally representative sample of primary care physicians and specialist physicians. Keep reading! Finally professionals attached great importance to their clinical independence as well as to scope for collaboration.
In the kind of emphasis on collaborative relationships with mental health specialists, the present results confirm the need to implement more collaborative practices among practitioners involved in mental health, not in the kind of the classic referral to specialists as the major therapeutic option.
It was organized along the lines of the individualized stepped care proposed by Von Korff and colleagues.
Patients who pose problem for their primary care physician will benefit from prompt public psychiatric consultations, or brief interventions in support of primary care management without transferring the responsibility to specialist care. Known only if necessary, will the transfer to specialist care by private or publics psychiatrists be organized.
Results from this survey been integrated into the South Yvelines Mental Health Network created in June 2001, by promoting this collaborative type relationships in this location.
In Ontario, Canada, a community survey has shown the influence of certain demographic variables on distribution of patients with mental health problems but not the influence of severity variables.
The results of the present study confirm the difference between patients with mental health problems encountered in primary care and those encountered in public psychiatric setting. Basically the difference is smaller between primary care and private psychiatric settings, where patients were actually more similar than different on demographics, diagnosis and severity criteria. Actually very few studies have explored PrP practice. Then, depressed patients consulting a psychiatric practitioner were reported as more severely depressed, more gonna be male, more highly educated and younger. So as a result in Michigan, USA, a study compared ‘criteriadefined’ MDD patients of GPs and psychiatrists. Now look, the authors concluded that depressed patients encountered in routine primary care are substantially different from those seen in psychiatric settings. Consequently, depressed primary care patients were less going to have received prior treatment for depression and less going to present past and current psychiatric comorbidity.
It is the first survey studying mental health patient distribution with a recruitment via the professionals, and comparing GPs, PuPs and PrPs.
It confirms that GPs had to cater for patients with severe mental health problems.
Severity is shown to influence the specialist/generalist division of responsibility for patients with mental disorders. Also, in the United States, a large, nationally representative sample of patient visits showed that men, African Americans, other non white persons, and patients under 15, between 65 and 74, and 75 and over, made proportionally more visits to primary care physicians than to psychiatrists. Anyways, regarding mental health practice, PuPs were radically different from both GPs and PrPs. PuP patients were younger, more often male and nonworking than GP and PrP patients.
Then the GP and PrP patients with mental health problems already known to the practitioner were very similar for gender and employment rate. Satisfaction with mental health practice was low for all categories of physicians. Because of psychiatrists’ workload, So there’s a lack of the collaboration felt to be necessary, and since GPs have specific needs in this respect, GP patients with mental health problems are very similar to patients of private psychiatrists.