Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland

Abstract

Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

Key Words::

• Primary care
• general practitioners
• mental health
• patients
• psychiatrists
• psychiatric care

Acknowledgements

We would like to express our profound gratitude to Professor Kevin Malone, Dr Anthony McCarthy, Dr Allys Guerandel, Dr Freda O’Connell and Ms Leah Quinlivan all of St Vincent's University Hospital in Dublin for their help in reviewing the questionnaire used in the study.

Statement of Interest

The authors have no conflicts of interests to declare.

Appendix I: Questionnaire

Shared Care for Psychiatric Patients between Specialised Psychiatric Services and Primary Care-

The Views of General Practitioners

1. Sex: Male ( ) Female ( )

2. Experience as a GP < 5 years ( ) 5–10 years ( ) > 10 ( )

3. Current region of practice: Munster ( ) Leinster ( ) Connaught ( ) Ulster ( )

4. Did you do a psychiatric rotation before or during your postgraduate general practice training?

   Yes ( ) No ( )

5. How confident are you about your ability to recognise and manage psychiatric presentations in primary care? Please circle appropriate number.

   Fully confident 5 4 3 2 1 Not confident

6. Do you manage some psychiatric presentations in your surgery without any input from specialised psychiatric services? Yes ( ) No ( )

7. On a scale of 1 – 5 where 1 means “not competent” and 5 means “very competent”, please rank your level of competence as regards which of the following patients you would feel competent managing in primary care without the input of specialised psychiatric services. ( please circle the appropriate numbers)

   • Depression 1 2 3 4 5

   • Bipolar Disorder 1 2 3 4 5

   • Anxiety Disorders 1 2 3 4 5

   • Alcohol Dependency Syndrome 1 2 3 4 5

   • Personality Disorders 1 2 3 4 5

   • Schizophrenia/Schizoaffective Disorder 1 2 3 4 5

   • Other, Please specify _____ 1 2 3 4 5

8. Do you have any psychiatric patients you manage jointly with specialised psychiatric services? Yes ( ) No ( )

9. How involved are you in the care of your patients’ who attend psychiatric services?

   • Not involved ( )

   • Medication prescribing ( )

   • Shared monitoring of mental state ( )

   • Shared monitoring of mental state and medication prescribing ( )

   • Other ( ) Please specify_____

10. Would you support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their medication?

    Yes ( ) No ( )

11. Would you have any reservations at all about a policy of shared care between primary care and specialised psychiatric services in the management of mental health patients stabilised on medication?

    Yes ( ) No ( )

12. If yes, what is your main concern?

    • Not in patients best interest ( )

    • Not the best use of available resources ( )

    • Not financially viable ( )

    • Would leave little for Psychiatrists to do ( )

    • Other ( ) Please specify_____

13. Do you see difficulties for patients in terms of obtaining psychiatric care in General Practice surgeries? Yes ( ) No ( )

14. If yes, please identify potential difficulties

    • Patients without medical cards need to pay for consultation as well as medication ( )

    • Patients may not feel confident about obtaining adequate psychiatric care from GP's ( )

    • Primary care is not adequately resourced with allied health professionals to support provision of psychiatric care ( )

    • Primary care providers not adequately trained to provide psychiatric care ( )

    • Lack of adequate interaction and cooperation between primary care and specialised mental health services ( )

    • Other ( )

      Please specify_____

15. Would you support a policy that makes GP attendance for medication and review of mental state free to all patients irrespective of being a medical cardholder or not?

    Yes ( ) No ( )

    Would you agree with the following statements concerning psychiatric patients stabilised on medication?

16. A policy of shared care between primary care and specialised psychiatric services in the management of mental health patients who are stable on medication would compromise the quality of patient care.

    Strongly Agree ( ) Agree ( ) No Opinion ( ) Disagree ( ) Strongly Disagree ( )

17. A policy of shared care between primary care and specialised psychiatric services in the management of mental health patients who are stable on medication would be a more cost effective way of caring for psychiatric patients.

    Strongly Agree ( ) Agree ( ) No Opinion ( ) Disagree ( ) Strongly Disagree ( )