How do General Practitioners experience providing care for their psychotic patients?

BACKGROUND: In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing care for these patients hinder the development and implementation of such guidelines. This study aims to explore the chances and problems GPs meet when providing care for patients susceptible for recurring psychoses, including schizophrenia and related disorders, bipolar disorder, and psychotic depression. METHODS: A qualitative study of focus group discussions with practising GPs in both town and rural areas. Transcripts from three focus groups with 19 GPs were analysed with the computer program 'Kwalitan'. Theoretical saturation was achieved after these three groups. RESULTS: Analysis showed that eight categories of factors influenced the GPs' care for psychotic patients: patient presentation (acute vs. chronic phase), emotional impact, expertise, professional attitude, patient related factors, patient's family, practice organization, and collaboration with psychiatric specialists. CONCLUSION: Current primary care for psychotic patients depends very much on personal characteristics of the GP and the quality of local collaboration with the Mental Health Service. A quantitative study among GPs using a questionnaire based on the eight categories mentioned above would determine the extent of the problems and limitations experienced with this type of care. From the results of this quantitative study, new realistic guidelines could be developed to improve the quality of care for psychotic patients

Care for patients with severe mental illness: the general practitioner's role perspective

BACKGROUND: Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. METHODS: A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. RESULTS: 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. CONCLUSION: GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients

Improving somatic health of outpatients with severe mental illness

Background: Patients with severe mental illness (SMI) experience a 13-to 30-year reduction in life expectancy compared with the general population. The majority of these deaths can be attributed to somatic health problems. The risk on somatic health problems is partly increased due to a reduced ability to request care and the fact that the current health care organisation is unable to fulfil the needs of these patients. Our previous work shows that a health check intervention can bypass the inability to request help of patients with SMI by detecting somatic health problems that were not detected previously [1]. The aim of this research project is to develop a policy recommendation on how to improve physical health based on consensus by the major stakeholders: patients, family carers, general practitioners, and mental health care staff. Methods: We used a three round Delphi method. The first round consisted of an inventory of potential policy recommendations, in two consecutive rounds consensus was sought on a selection of recommendations. Results: The policy recommendations described improvement in collaboration among health care professionals; the need to educate involved professionals regarding the specific medical risks associated with patients with SMI; and defining the differences between GPs and mental health care professionals regarding their responsibilities to provide adequate care for the physical health of SMI patients. Examples of consensus based policy recommendations on colloboration are: The GP is the professional with overview and direction of the complete (general and specialist) treatment of patients. The professional (MHP or GP) who diagnoses a new somatic complication should notify the other professional (MHP or GP) providing them with relevant medical information.-o The results from cardiovascular risk screening need to be known by the GP and MHP. The performer of the screening should inform the other party in writing. For the policy on new physical symptoms, MHP should always consult the GP. Consultation with the GP is necessary before referral to a medical specialist by MHP. Changes in medication should always be reported in writing between MHP and GP. The psychiatrist can delegate the performance of the necessary screening required for some medications used in the treatment of psychiatric disease to the GP, if the patient agrees. Direct personal contact between MHP and GP is an important prerequisite for improving cooperation. Sharing of direct (cell)phone numbers can contribute in facilitating direct contact. Discussion: Currently there are multiple barriers to optimal health care which can be overcome by implementing the suggested policy recommendations. Part of these recommendations can be implemented directly in current health care