Abstract
BackgroundReform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD). There has also been a growing awareness of the high somatic morbidity among SMD patients, an obvious challenge for general practitioners (GPs). The aim of this study was to assess the utilisation of GP services by patients with schizophrenia.MethodsThe Norwegian list patient system is based on fee-for-service (FFS). For each contact, the GPs send a claim to National Health Insurance detailing the diagnosis, the type of contact, procedures performed, and the personal identifier of the patient. In this study complete GP claims data from 2009 for schizophrenia patients aged 25–60 years were used to assess their utilisation of GP services. Regression models were used to measure the association between patient, GP and practice characteristics, with FFS per patient used as a measure of service utilisation. Data on patients with diabetes (DM) and population means were used for comparison.ResultsThe mean annual consultation rate was 5.0 and mean FFS was 2,807 Norwegian Kroner (NOK) for patients diagnosed with schizophrenia. Only 17% had no GP consultation, 26.2% had one or two, 25.3% had three to five, and 16.1% more than five consultations. GPs participated in multidisciplinary meetings for 25.7% of these patients. In schizophrenia patients, co-morbid DM increased the FFS by NOK 1400, obstructive lung disease by NOK 1699, and cardiovascular disease by NOK 863. The FFS for schizophrenia patients who belonged to a GP practice with a high proportion of mental health-related consultations increased by NOK 115 per percent point increase in proportion of consultations. Patients with schizophrenia living in municipalities with < 10,000 inhabitants had a mean increase in FFS of NOK 1048 compared with patients living in municipalities with > 50,000 inhabitants. Diagnostic tests were equally or more frequent used among patients with schizophrenia and comorbid somatic conditions than among similar patients without a SMD.ConclusionThis study showed that most patients diagnosed with schizophrenia had regular contact with their GP, providing opportunities for the GP to care for both mental and somatic health problems.
Highlights
Reform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD)
The first aim of the study was to increase the knowledge about the contribution of general practitioners (GPs) to the care of patients with SMD, by assessing how schizophrenia patients used GP services with respect to both mental and somatic health problems
Main findings In Norwegian general practice, the mean annual consultation rate for patients diagnosed with schizophrenia was 5.0 in 2009; 17% had no consultations in 2009, 26.2% had one or two, 25.3% had three to five, and 16.1% more than five consultations
Summary
Reform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD). There has been a growing awareness of the high somatic morbidity among SMD patients, an obvious challenge for general practitioners (GPs). Over the last few decades, reforms have resulted in primary care services having increased responsibility for patients with serious mental disorders (SMD) though there are important variations between countries [1,2]. In Norway, the municipal health services have been strengthened by recruitment of a large number of mental health care workers, while the resources for general practitioner (GP) services have increased only slightly [3]. GPs are the first line of contact for patients with mental health problems. In Norway, GPs prescribe nearly 70% of all antipsychotic medications [8]
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