RESUMEN
BACKGROUND: The high demand for mental health care is increasing the pressure on Dutch basic and specialized mental health care. Consultative psychiatry in primary care may help to support primary mental health care. These consultations are increasingly used nationwide. However, little is known about how this help takes shape in practice and what the experiences of both patients and caregivers are. METHOD: We carried out a database and file study into the characteristics of the patients who received psychiatric consultation, in which we also examined the consultation questions of the general practitioners (GP) and the given advice. In addition, 15 semi-structured in-depth interviews were conducted with patients, general practitioners, mental healthcare nurse practitioners and psychiatrists, after which the transcripts were coded and analyzed thematically. AIM: To explore for which patients the GP requests a psychiatric consultation, what the consultation questions are and the advice given, and to identify the experiences of patients and healthcare providers with consultative psychiatry in general practice. RESULTS: The database study showed that consultative psychiatry was mainly used for patients with a psychiatric history, multiple psychiatric diagnosis and current psychopharmaceutical use. The consultation question usually concerned medication or treatment advice. In addition to advice regarding the consultation question, the psychiatrist often gave additional advice. Consultative psychiatry was experienced positively by both health care providers and patients due to the low threshold of the general practice, the mutual trust that is involved, the short waiting times compared to the second and third line psychiatry and the expertise of the psychiatrist. CONCLUSION: Consultative psychiatry in general practice is widely applicable, but is mainly applied to patients with multiple psychiatric diagnoses and current psychopharmaceutical use. It is experienced as positive by both patients and healthcare providers.
Asunto(s)
Medicina General , Trastornos Mentales , Psiquiatría , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Derivación y Consulta , PsicotrópicosRESUMEN
OBJECTIVE: The aim of this study was to assess the effect of the family physician on improving compliance with follow-up of abnormal smears in cervical cancer screening. DESIGN: Observational study. SETTING: Two Regional Health Authority districts in the east of The Netherlands. STUDY PARTICIPANTS: Family practices with a national call system for cervical cancer screening and family practices with a family-practice-based call system. In a number of practices the family physicians had introduced a fail-safe system for follow-up. MAIN OUTCOME MEASURES: Follow-up of women who participated in the first screening round and in whom a cytological abnormality had been diagnosed in the first smear. Criteria for adequate follow-up were defined with regard to the severity of the cytological abnormality. RESULTS: The overall compliance with follow-up in the study-group was 88%. The study showed a strong relationship between involvement of the family physician and compliance with follow-up. The compliance in practices that had a fail-safe system for follow-up was 93% compared to 82% in the practices without a fail-safe system. The highest follow-up was found in practices involved in the family-practice-based system.