Abstract
GPs have an important position in the identification of patients’ mental health problems. As generalists, GPs are often the first health professionals contacted by patients with mental health problems and they are assigned to provide integrated care for both patients’ somatic and psychological problems. Early recognition and diagnosis of patients’
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mental health problems are important because it may avoid the patients’ complaints deterioration, relieve their burden, and increase the possibility of further support and treatment. But GPs are sometimes reluctant to get involved in their patients’ mental health problems because these problems ask for extra time and energy. They mention lack of time and workload as obstacles in their involvement in patients’ mental health problems. In this thesis the relationship between GPs’ workload and their involvement in patients’ mental health problems is explored.
Secondary analyses were made from the Second Dutch National Survey of General Practice, a cross-sectional survey that was carried out from 2000 till 2002. This National Survey was conducted in 104 Dutch general practices with 195 GPs, and a practice population of 385,461 patients. A medical record (roughly 1.5 million contacts in total), a video observation of 2095 consultations from 142 GPs, questionnaires among participating GPs and patients, and a detailed log of GPs’ use of time were analysed.
Results show that patients’ mental health problems demand extra time and energy from GPs. Patients make greater demands on general practice and consultations are more demanding, especially when patients have somatic problems with psychological aspects playing a part in the background. But GPs who pay more attention to their patients’ mental health problems do not have a higher overall workload compared to GPs who are more focused on patients’ somatic problems. Furthermore GPs with a high objective or subjective workload do not make less mental health assessments in their consultations compared to GPs with a lower workload.
GPs with a high subjective workload show different communication patterns compared to GPs with a lower subjective workload. When GPs experience a lack of time before the consultation starts, they are less patient-centred in the consultation. This is unfavourable for a patient with mental health problems. But when GPs are overall dissatisfied with the available time, or have feelings of burnout, they show more communication that may encourage the patient to disclose their mental health problems, and their consultations take longer. It seems that especially GPs with the most intensive patient contacts are dissatisfied with the available time and are at risk to develop feelings of burnout.
GPs can be supported in fulfilling their mental health role by other mental health services, as for example when a ‘nurse practitioner mental health care’ is deployed in general practice. GPs may also be supported in their mental health tasks by offering financial support for the extra time they spend on their patients’ mental health problems. Finally, patients’ direct disclosure of their mental health problems may spare GPs’ time and energy both during the consultation and in future consultations.
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