Assessment of efficacy of specialized psychiatric assistance for patients with combined mental and somatic pathology

2011 ◽  
Vol 26 (S2) ◽  
pp. 874-874
Author(s):  
V.F. Lebedeva ◽  
V.Y. Semke
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Clinical Improvement ◽  
Integrative Approach ◽  
Primary Care Unit ◽  
Psychiatric Institution ◽  
Medical Network ◽  
Treatment Measures ◽  
Somatic Disorders ◽  
Gradual Approach

Objective and methodsUse of developed prophylactic and rehabilitative programs based on city primary care unit and psychiatric services of psychiatric institution has allowed improvement of quality of life, high clinical and economic efficacy of treatment of patients with combined mental and somatic pathology.ResultsAccording to data of catamnesis (2–9 years) in group of patients in need for course therapy according to addressing, recovery has been achieved in 46,2% of cases, stable clinical improvement - in 44,1%; in group of patients in need for systematic therapy and dynamic observation, recovery has been achieved in 24,7% of cases, stable clinical improvement - in 65,5%. The most effective measures were at initial stages of mental disorders. Differentiated gradual approach to treatment of combined mental and somatic disorders under conditions of general medical institution and principle of continuum of treatment measures have allowed reducing transient disability in 1,8 times, number of not based addressing and examinations per 1 patient in 2,3 times.ConclusionIntegrative approach to medical assistance rendering for patients with mental disorders, revealed in general medical network is enough effective. Successful interaction of psychiatrists of primary care unit, internists, psychiatrists of dispensary and hospital was contributed by principles: collective character of decision making, continuum in resolution of issues of treatment-prophylactic assistance, observation of principles of medical ethics and deontology oriented at interests of patients, accomplishment of treatment-diagnostic assistance, necessary in such an amount that maximum therapeutic effect was achieved during rational use of medical resources.

Improving Primary Care in Patients With Mental Disorders

2010 ◽  
Author(s):  
Benjamin G. Druss ◽  
Silke A. von Esenwein
Keyword(s):  
Primary Care ◽  
Mental Disorders

scholarly journals Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires

2007 ◽  
Vol 38 (2) ◽  
pp. 221-228 ◽  
Author(s):  
V. Patel ◽  
R. Araya ◽  
N. Chowdhary ◽  
M. King ◽  
B. Kirkwood ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
General Health Questionnaire ◽  
Diagnostic Interview ◽  
Systematic Sampling ◽  
Health Questionnaire ◽  
Primary Care Settings ◽  
Self Reporting Questionnaire ◽  
Distress Scale

BackgroundScreening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.MethodAdult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).ResultsComplete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.ConclusionsThere is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.

scholarly journals The Influence of Administrative Factors on Performing Primary Care Unit Standard Evaluation

2015 ◽  
Vol 186 ◽  
pp. 1075-1080
Author(s):  
Prachak Bouphan ◽  
Tang Keow Ngang ◽  
Chanya Apipalakul
Keyword(s):  
Primary Care ◽  
Primary Care Unit ◽  
Unit Standard

Somatization in Primary Care: A Comparative Survey of Immigrants from Various Ethnic Groups in Rome, Italy

2005 ◽  
Vol 35 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Massimiliano Aragona ◽  
Lorenzo Tarsitani ◽  
Francesco Colosimo ◽  
Barbara Martinelli ◽  
Hassan Raad ◽  
...  
Keyword(s):  
Primary Care ◽  
Ethnic Groups ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Central Americans ◽  
Primary Care Unit ◽  
Primary Care Settings ◽  
South Central ◽  
Current Prevalence ◽  
Comparative Survey

Objectives: Those responsible for interviewing immigrants in primary care settings often underestimate the importance of somatic symptoms arising from psychological distress. This study investigates the current prevalence of somatization in immigrants, and evaluates the comparative rates of somatic complaints in four ethnic groups (Caucasians, Asians, South/Center Americans, and Africans). Methods: We studied the 301 consecutive outpatients (aged between 16 and 70 years) attending the “Caritas” primary care unit for immigrants in Rome (Italy) from January to December 2003, all of whom completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or more on the BSI-21 were considered at risk for somatization. Results: The current prevalence of somatization was 35.2%; 62.3% of the somatizers were women. A multiple regression analysis adjusting for the possible confounding effects of sex, age, education, and months of stay in Italy showed that South/Central Americans had significantly higher somatization scores than the other three groups. Conclusions: These findings suggest a high probability of somatization syndromes in immigrant patients. South/Central Americans tend to somatize more than other ethnic groups. A psychosomatic approach may be useful for immigrants in primary care settings.

scholarly journals Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Michel ◽  
A J Hammami ◽  
K Chevreul
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
Mental Illness ◽  
Mental Disorders ◽  
Economic Burden ◽  
Mentally Ill ◽  
Hospital Costs ◽  
Healthcare Systems ◽  
Interaction Terms

Abstract Background People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it. Methods An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms. Results 37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients. Conclusions Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance. Key messages There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.

scholarly journals Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053624
Author(s):  
Daniel Smith ◽  
Kathryn Willan ◽  
Stephanie L Prady ◽  
Josie Dickerson ◽  
Gillian Santorelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Mental Disorders ◽  
Outcome Measures ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Common Mental Disorders ◽  
Free Text ◽  
Primary Care Data ◽  
Time Point

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

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