Variables associated with general practitioners taking on serious mental disorder patients.

Marie-Josée Fleury,Jean-Marie Bamvita,Jacques Tremblay

doi:10.1186/1471-2296-10-41

Marie-Josée Fleury, Jean-Marie Bamvita + Show 1 more

Open Access

https://doi.org/10.1186/1471-2296-10-41

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Abstract

BackgroundAs part of community-based initiatives to strengthen integrated care and promote patient recovery, GPs are asked to play a greater part in treating serious mental disorder (SMD) patients. All current healthcare reforms favour the reinforcement of primary care. More information on enhancing the role of GPs in mental health would benefit policymakers, especially as regards SMD patients, where little research has been published as yet. This article assesses variables associated with GPs taking on SMD patients.MethodsThe study, encompassing multiple sites, is based on a sample of 398 GPs, representative of the GP population in the Canadian province of Quebec. GPs were asked to answer a 143-item questionnaire on their socio-demographic and clinical practice profiles, patient characteristics, perceived inter-professional relationships and quality of care. Descriptive, bivariate and multivariate analyses were performed.ResultsOur data highlighted that GPs currently followed up only a minority of SMD patients on a continuous basis and far fewer for both physical and mental health problems. A linear regression model that accounts for 43% of the variance was generated. The best variables associated positively with GPs taking on SMD patients were: frequency of referrals for joint follow-up with other resources, and involvement in post-hospitalization follow-up. Conversely, lack of expertise in mental health (related in our model to frequency of mental disorder patient transfer due to insufficient mental health training) is associated with a lower incidence of GPs taking on patients.ConclusionAs advocated in current healthcare reforms, our study confirms the need to promote greater GP involvement in integrated care models and enhance their training in mental health – thereby helping to reverse the trend among GPs of transferring SMD patients to specialized care. Patients with stable SMDs ought to have the same care access as the general population.

Highlights

As part of community-based initiatives to strengthen integrated care and promote patient recovery, general practitioners (GPs) are asked to play a greater part in treating serious mental disorder (SMD) patients
Variables associated with GPs taking on SMD patients The final multiple linear regression model is shown in Table 4, consisting of six variables organized in three sets
Three sets of variables were associated with GPs taking on SMD patients: (1) their level of expertise toward treating those patients; (2) their inter-professional relationship feature; and (3) their clinical practice profile

Summary

Introduction

As part of community-based initiatives to strengthen integrated care and promote patient recovery, GPs are asked to play a greater part in treating serious mental disorder (SMD) patients. In Canada, two such examples in mental health are sharedcare [14,15] and integrated service network models [1517], which aim at improving care co-ordination among GPs, psychiatrists and multidisciplinary mental health providers, or within the healthcare system as a whole. These models usually include a broad spectrum of integration strategies and best practices such as clinical guidelines, electronic medical records, case management, capitation and performance incentives for GP remuneration, and patient self-management support [14,16,18]. It has been shown that these innovative integrated models improve care continuity and more appropriately meet the needs of mental health patients living in the community [19,20]

Results

Discussion

Conclusion