General Practice Research Unit Research Articles

Conversation with Raul Caetano

In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the Journal's field of interest. Raul Caetano qualified in medicine in Brazil. While retaining close academic and cultural links with his native country, he has developed a career as an alcohol epidemiologist with research positions first in Berkeley,California and then at the University of Texas. He has contributed very widely to epidemiological research on drinking but with a sustained ability to develop the important ethnic dimensions of such studies.

W03-04 - The use of internet in the treatment of depression in general practice (ICBT in GP)

ICBT in GP is a joint project between General Practice Research Unit and the Research Group of Mental E-Health at the Department of Psychology, Faculty of Health Sciences, University of Tromsø, Norway. In Norway the yearly incidence of depression is 7% and rapidly increasing. Two thirds of the patients experiences recurrence within 10 years. The yearly treatment costs of depression is 200 millions Euros. The burden on specialist health care is heavy with waiting lists of 3 to 6 months. The Norwegian Directorate of Health recommends that patients with mild to moderate depression should be treated in General Practice (GP). Self help programs should be introduced in the treatment. The aim of the present project is to develop a strategy whereby general practitioners will use the internet as a treatment option for mild to moderate depression and to measure the effect of this treatment. We will use the internet-based self help program MoodGYM. The program has five treatment and evaluation modules. MoodGYM reduces symptoms of depression, but few patients complete all modules. If patients have a consultation with their GP between each module, they may be more motivated to fulfil the program. In addition, MoodGYM provides the GP with a tool to evaluate the severity of symptoms.The presentation will focus on the economic and structural properties facilitating the use of internet in treatment of depressed patients in GP.

Looking back over my professional life

Looking back over my professional life

Anthony Ward Clare

Anthony Ward Clare

Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970–1982

Data from the Second and Third National Studies of Morbidity Statistics from General Practice, conducted from 1970 to 1972 and 1981 to 1982, respectively, by the General Practice Research Unit of the Royal College of General Practitioners, were analyzed to estimate morbidity rates of RA and examine changes in these rates over time. The age-adjusted annual incidence of RA in females fell from 3.3 to 2.6 cases per 1,000 person-years from 1970 to 1972 and 1980 to 1981; there was no change observed in males. Over the same time interval, there was a rise in age-adjusted period prevalence of RA in both sexes from 6.4 to 7.5 per 1,000 and 2.8 to 3.5 per 1,000 in females and males, respectively. These data, which should be interpreted with caution, confirm a decline in incidence of RA in females and demonstrate an increase in prevalence of RA in both sexes over the past decade.

The General Practice Research Unit at the Institute of Psychiatry.

The General Practice Research Unit (GPRU) was established at the Institute of Psychiatry in the late 1950s, under the honorary directorship of Professor Michael Shepherd. For 30 years it has been staffed by medically qualified workers and social scientists supported, at various times, by the Nuffield Foundation, the Mental Health Research Fund, and the Department of Health and Social Security, as well as by university monies.

Participating in primary care

Traditionally, general practitioners and psychiatrists relate to one another through a system of cross referrals, from primary care to secondary care and back again, the referral being initiated by the GP through a request for a domiciliary visit or more usually for an out-patient assessment of the clinical problem. However, in the mid-1960s, individual psychiatrists began to report a new way of working, which consisted of the psychiatrist going by invitation into GPs' surgeries or health centres to work directly with the general practitioners and with other members of the primary health care team. A survey undertaken by Strathdee & Williams of the General Practice Research Unit of the Institute of Psychiatry, showed that by 1984 in England and Wales, one psychiatric consultant in five, sometimes with, sometimes without, junior staff, spent some time in a general practice setting. At the College meeting in Cambridge (April 1988), Pullen reported that in Scotland a similar survey showed that as many as 40 to 50% of psychiatric consultants spent some time in primary care settings.

Mental Illness in Primary Care Settings

A Conference on the above topic took place at the Institute of Psychiatry, London, on 17 and 18 July 1984. The Conference was sponsored by the Department of Health and Social Security and was organized by the General Practice Research Unit. Over 100 invited clinicians, research workers and policy-makers took part. The majority of the participants were either psychiatrists or general practitioners, but representatives of all relevant disciplines attended.

The efficiency of measles and pertussis notification in England and Wales.

This paper examines methods for estimating the efficiency of measles and pertussis notification with particular reference to England and Wales. Crude estimates are obtained from a comparison of annual numbers of births and notifications, and this approach is modified to include detailed age-specific data. Other sources of data, notably the Hospital In-Patient Enquiry, are used to give detailed estimates over time. These analyses provide evidence for a strong positive correlation between notification efficiency and incidence for both diseases and for a dramatic fall in the notification efficiency for pertussis between 1957 and 1976. This decrease is of particular interest insofar as it could explain in part the apparent fall in size of successive pertussis epidemics during that period. It is estimated that since 1976 the spotter practices of the Royal College of General Practitioners General Practice Research Unit have been approximately 1.5 times more efficient at reporting measles and 2.5 times more efficient at reporting pertussis than the national average for reporting to the Office of Population Censuses and Surveys. Finally it is noted that estimates of notification efficiency are positively correlated with the assumed level of vaccine efficacy, and that all these methods require assumptions concerning the proportion of vaccinations which are recorded, the proportion of vaccinations which are successful in immunizing the recipient, and the proportion of the population which ultimately contracts the infection. In general, measles notification in England and Wales is considerably better than that for pertussis, being of the order of 40-60% for the former and only 5-25% for the latter.

Forthcoming Events

The Department of Health and Social Security is sponsoring a conference on ‘Mental Illness in Primary Care Settings’ which will be held at the Institute of Psychiatry on 17 and 18 July 1984. The conference is being organized by the General Practice Research Unit. Topics will include classification, screening, treatment effectiveness, patterns of collaboration, international developments and future trends for research and policy. Although attendance will be by invitation only, limited places may be available. Those interested should contact Dr D. G. Wilkinson, General Practice Research Unit, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AZ, from whom further information is available.

Psychiatric Illness in General Practice

This is not a textbook of how one recognizes and treats a variety of psychiatric illnesses in general practice, as is suggested by the title. Rather, it is a republication of an important research study on psychiatric illness in general practice done by the General Practice Research Unit of the Institute of Psychiatry at the University of London. The study was originally published in 1966, and it is here reissued in its entirety. It is supplemented by a summary of the work in the area done between 1966 and 1980. The original study was important but, as pointed out by the authors, did not receive the attention warranted until general interest in the interface between general practice and psychiatry began to emerge in the late 1970s. This interface has played a major role in the family practice movement in this country, and as it is emerging around the world. If

The General Practice Research Unit at the Institute of Psychiatry.

The General Practice Research Unit at the Institute of Psychiatry.