Abstract

BackgroundSince 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse.MethodsThe Netherlands Institute for Health Services Research (NIVEL) retrieved data of a representative sample of general practices (n = 155) for this study. Data were aligned at the starting point of the implementation of the PN-MH to compare the practices on our outcome measures after implementation of the PN-MH. Multilevel regression analyses were conducted to investigate differences in average number of chronic and acute alcohol abuse diagnoses between practices with a practice nurse mental health and control practices (without a practice nurse mental health and without a primary care psychologists).ResultsA significant decrease over time of chronic alcohol abuse diagnoses was observed (ß = -.52, p < 0.05) as well as a significant decrease over time of acute alcohol abuse diagnoses (ß = -.06, p < 0.05). After adjustment for multiple comparisons, no significant differences were found between practices that implemented a practice nurse mental health or only have a primary care psychologist and control practices. Practices that implemented a practice nurse mental health and have a primary care psychologist, had a higher mean of chronic and acute alcohol abuse diagnoses than control practices during all periods, but the differences between these groups were not statistically significant.ConclusionsBased on the results of this study it seems that the introduction of practice nurses mental health in general practices is not associated with increased diagnoses of chronic or acute alcohol abuse. Potential explanations are barriers experienced by practice nurses to addressing alcohol use with patients and prioritization of other mental health issues over alcohol abuse. In order to improve the management of alcohol abuse by practice nurses, more research is needed on how practice nurses can be involved in diagnosing and treatment of patients with alcohol abuse.

Highlights

  • Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care

  • Practice characteristics Data were obtained from a total of 155 general practices, of which 46 practices are control practices, 23 practices only have a primary care psychologist (PCP), 56 practices only have a Practice Nurse Mental Health (PN-MH) and 30 practices have both a PN-MH and PCP

  • General practitioners have an average workload of 2.35 Full-time equivalent (FTE) (Table 1)

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Summary

Introduction

Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse. Alcohol problems are frequently not discussed or recognized in primary health care [6,7,8]. Lack of time and lack of access to necessary (low-threshold) services are mentioned by GPs as important barriers for discussing alcohol use and delivering brief interventions [7, 9]

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