scholarly journals Mental disorders in primary care

2003 ◽  
Vol 5 (2) ◽  
pp. 115-128 ◽  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
General Practitioners ◽  
Multiple Solutions ◽  
Care Setting ◽  
Primary Care Setting ◽  
The Past ◽  
Single Solution ◽  
Mental Pathology

Current estimates indicate that 50% of the population experience at least one mental disorder in their lifetime and that at least 25% have suffered a mental disorder in the past year. recognition, diagnosis, treatment, and referral depend overwhelmingly on general practitioners, at least one third of whose consultations have a direct and explicit psychological component. Yet despite this intensive familiarization with the presentation of mental pathology, and the appropriateness of the primary care setting to its management, even the most recent surveys indicate that performance is best described by the rule of diminishing halves: only half the patients with a thresh-old disorder are recognized; only half of those recognized are treated; and only half of those treated are effectively treated. There is no single solution to this problem, only multiple solutions, which must be aimed, consistently and simultaneously, at the patient, practitioner, practice, and research levels.

scholarly journals Consultation liaison in primary care for people with mental disorders

2016 ◽  
Vol 22 (2) ◽  
pp. 74-74 ◽  
Author(s):  
Donna Gillies ◽  
Penny Buykx ◽  
Alexandra G. Parker ◽  
Sarah E. Hetrick
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Care Setting ◽  
Primary Care Setting ◽  
Mental Healthcare ◽  
Adequate Treatment ◽  
Health Specialist ◽  
Negative Impacts

Approximately 25% of people will be affected by a mental disorder at some stage in their life. Despite the prevalence and negative impacts of mental disorders, many people are not diagnosed or do not receive adequate treatment. Therefore primary healthcare has been identified as essential to improving the delivery of mental healthcare. Consultation liaison is a model of mental healthcare where the primary care provider maintains the central role in the delivery of mental healthcare, with a mental health specialist providing consultative support. Consultation liaison has the potential to enhance the delivery of mental healthcare in the primary care setting and, in turn, improve outcomes for people with a mental disorder.

Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic

2018 ◽  
Vol 89 (4) ◽  
pp. 897-908 ◽  
Author(s):  
Issa Papiss Bagayogo ◽  
Katharina Turcios-Wiswe ◽  
Kanako Taku ◽  
Lauren Peccoralo ◽  
Craig L. Katz
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
New York ◽  
New York City ◽  
Mental Health Services ◽  
Health Services ◽  
General Practitioners ◽  
York City ◽  
Care Setting ◽  
Primary Care Setting

How general practitioners treat migraine patients—evaluation of a headache guideline

Cephalalgia ◽  
2012 ◽  
Vol 32 (12) ◽  
pp. 908-915 ◽  
Author(s):  
R Zielman ◽  
PJL Veenstra ◽  
EW van Zwet ◽  
JSP van den Berg
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Pharmacological Treatment ◽  
Care Setting ◽  
Primary Care Setting ◽  
Referral Letter ◽  
Hospital Record ◽  
Specific Medication ◽  
History Of ◽  
First Time

Aim: The aim of the study was to evaluate the pharmacological treatment of migraine patients by general practitioners before referral to a neurologist. First, was the pharmacological treatment in accordance with the Dutch College of General Practitioners headache guideline? Second, which migraine characteristics were associated with receiving migraine-specific medication? Methods: Migraine patients (age ≥18 years) who visited the neurology outpatient clinic for the first time were included. Migraine characteristics and pharmacological status were collected retrospectively for each patient from the general practitioner’s referral letter, hospital record and a headache characteristics questionnaire. Results: A total of 420 migraine patients were included. Only 18.3% of the patients with two or more migraine attacks per month were using prophylactic medication. Furthermore, only 11.7% of patients with symptoms of nausea and/or vomiting were using anti-emetic medication. More than half of patients (51.7%) were using triptans and were likely to have typical migraine symptoms and a long history of migraine. Conclusions: Migraine prophylactic medication and anti-emetics are underutilized in the primary care setting for migraine patients in the Netherlands, when compared to the general practitioners guideline. It is important to enhance the knowledge of general practitioners regarding the diagnosis of migraine, and to increase awareness of the headache guideline.

Detection, assessment and management of eating disorders; how involved are GPs?

2006 ◽  
Vol 23 (3) ◽  
pp. 96-99 ◽  
Author(s):  
Claire Flahavan
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Eating Disorders ◽  
General Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Screening Tools ◽  
Current Evidence ◽  
Eating Disordered ◽  
Screening Assessment

AbstractObjectives: To determine the extent to which general practitioners are currently active in the screening, assessment, diagnosis and management of eating disorders. To identify current deficits in service delivery for eating disordered patients, as identified by general practitioners.Method: A postal questionnaire was circulated to 360 general practitioners within the greater Dublin area and North Eastern Health Service Executive.Results: Response rate was 25%. Respondents had lower case-loads of eating disordered patients than would be expected given the epidemiology of anorexia and bulimia nervosa. Most do not routinely screen for eating disorders, even in at-risk populations and are unaware of the current evidence-based data for guidance. GPs do not feel confident at managing eating disorders within the primary care setting and see their chief role as that of referral to psychiatric services. Treatment outcomes are typically poor. Concern was expressed at the lack of access to specialist treatment in the public sector. Specific deficits in service provision were highlighted including delays in assessment, lack of services appropriate to the adolescent population, poor service transition, and poor availability of psychotherapy at primary care level.Conclusions: Eating disorders are currently underdiagnosed in the primary care setting. Use of simple screening tools might aid detection of pathological eating patterns, particularly in at-risk groups. General practitioners feel under-equipped to manage these complex disorders, given that the resources required to provide high quality care are not widely available. Better integration of primary and secondary services, coupled with training for GPs in the area of screening, assessment and diagnosis, may lead to earlier intervention and improved outcomes.

scholarly journals What is the significance of guidelines in the primary care setting?

2021 ◽  
Author(s):  
Julian Wangler ◽  
Michael Jansky
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Evidence Based ◽  
Online Questionnaire ◽  
Positive Effects ◽  
Ability To Act ◽  
Wide Range

SummaryMedical guidelines aim to ensure that care processes take place in an evidence-based and structured manner. They are especially relevant in outpatient primary care due to the wide range of symptoms and clinical pictures. In German-speaking countries, there is a lack of current findings documenting general practitioners’ opinions and experiences regarding guidelines, their expectations and their views on what improvements could be made to increase the use of this type of evidence-based instrument in the primary care setting. Between April and August 2020, a total of 3098 general practitioners were surveyed in the states of Baden–Württemberg, Hesse and Rhineland–Palatinate via an online questionnaire. Alongside the descriptive evaluation, t‑testing was used to determine significant differences between two independent sampling groups. A factor analysis was also used to cluster the expectations of those surveyed regarding the fulfilment of requirements relating to guidelines. A total of 52% of those surveyed have a positive view of guidelines. Overall, guidelines are associated with an increased evidence-based approach (69%), standardisation of diagnosis and treatment (62%) and a reduction in overprovision or underprovision of care (57%). In all, 62% of the physicians who implemented guidelines observed positive effects on the quality of care provided, and 67% reported that the implementation of guidelines improved the quality of their diagnostic or therapeutic skills. However, implementation is often seen as being complicated (43%) and restricting the physician’s ability to act independently (63%). Survey participants suggested that guidelines could be optimised by giving greater consideration to nondrug alternatives (46%), focusing on issues related to quality of life (42%) and offering a comparative assessment of various treatment options (39%). In order to further promote the attractiveness of guidelines for primary care the design of guidelines should be oriented more towards their application; they should be well-presented to make them easier to implement. The scope of action available to the physician should be stressed. The guidelines should provide recommendations on opportunities for the delegation of tasks within practice teams.

scholarly journals 1428. Increased Consumption of Pivmecillinam in Primary Care for Uncomplicated Urinary Tract Infection (uUTI) Is Not Associated With Increased Resistance Rates

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S796-S796
Author(s):  
Anders Rhod Larsen ◽  
Anne Santerre Henriksen ◽  
Niels Frimodt-Møller
Keyword(s):  
Primary Care ◽  
Antimicrobial Resistance ◽  
Care Setting ◽  
Primary Care Setting ◽  
Active Form ◽  
Resistance Rate ◽  
Uncomplicated Urinary Tract Infection ◽  
E Coli ◽  
The Past ◽  
Development Of Resistance

Abstract Background The evolution of antibiotic resistance in Escherichia coli (E. coli) hampers the treatment of UTIs, mirroring the global public health concerns around antimicrobial resistance. Pivmecillinam, an oral prodrug of mecillinam (a β-lactam antibiotic), is used as first-line treatment for uUTIs in Denmark. Here, we examine the use of, and the prevalence of resistance to, mecillinam in Denmark in the primary care setting. Methods Nationwide data on the use of and resistance to pivmecillinam (reported as its active form, mecillinam) was extracted and examined from the Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP) 2019 report (www.danmap.org). Prevalence estimates of resistance reported by DANMAP 2019 were obtained from the Danish Microbiology Database (MiBA). Results In 2019, pivmecillinam accounted for about 27% of penicillins and 75% of penicillins with extended spectrum consumed in primary healthcare in Denmark. Pivmecillinam usage has increased primarily due to changes in recommendations for the treatment of uUTIs. Between 2010 and 2019, pivmecillinam usage in Denmark increased by 45% from 1.67 to 2.43, defined as daily doses per 1,000 inhabitants per day. In 2019, analysis of 83,850 urinary isolates from patients in the primary care setting with E. coli revealed a 5.3% resistance rate to mecillinam. Time-trend analysis using data from a 10-year period showed a small but significant decrease from the 5.5% resistance rate recorded in 2010 (p=0.001). In general, in spite of increasing use in Denmark, the development of resistance to pivmecillinam has remained low. In fact, a slight decline in pivmecillinam resistance was observed over the past decade. Conclusion Despite the rising number of UTIs and the increasing use of pivmecillinam for uUTI in Denmark, over the past decade, the development of resistance to pivmecillinam remains low. Disclosures Anne Santerre Henriksen, MS, Advanz (Consultant)Shionogi BV (Consultant)UTILITY Therapeutics (Consultant)

scholarly journals Audit of a psychiatric liaison service – the value of general practice casenotes

1990 ◽  
Vol 14 (12) ◽  
pp. 727-729 ◽  
Author(s):  
Sheila M. Curran ◽  
Ian M. Pullen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Number Of Patients

The practice of out-patient psychiatry has undergone a number of significant developments in recent years: the number of patients referred by general practitioners has steadily increased: a large number of psychiatrists are now seeing patients in the primary care setting and more patients are being seen on one occasion only.

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