General Practitioners opinions on their practice in mental health and their collaboration with mental health professionals.Reportar como inadecuado

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1 Service de Psychiatrie 2 Troubles du comportement alimentaire de l-adolescent 3 Direction de la Politique médicale 4 Fondation de santé publique

Abstract : BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1 to evaluate GPs- opinions on their day-to-day practice with Patients with Mental Health Problems PMHP and on relationships with Mental Health Professionals MHPro; 2 to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France n = 492 were informed of the implementation of a local mental health program. GPs interested in taking part n = 180 were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period n = 1519. For each PMHP, data was collected on demographic and clinical profile, and on needs met v. unmet for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care 83.4%, more time 92.3%, more frequent consultations 64.0% and as being more difficult to refer 87.7% than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists 49.5%, public psychiatrists 35% and social workers 27.8%. 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.

Autor: Nadia Younes - Isabelle Gasquet - Pierre Gaudebout - Marie-Pierre Chaillet - Viviane Kovess - Bruno Falissard - Marie-Christine H



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