Assessment of psychological care in general practice

Abstract

Objective: To pilot a method of assessing psychological care by general practitioners.

Design: Prospective examination of psychological care given in general practice by using general health questionnaire with predetermined quantifiable and case specific indices of outcome established at the original consultation.

Setting: Rural general practice in Clwyd, North Wales.

Subjects: 447 consecutive adult general practice attenders.

Main outcome measures: Three month follow up consultation rates, one year retrospective consultation rates, continuity of care, changes in general health questionnaire scores at follow up, general satisfaction, and acceptability of outcome measures.

Results: The principal and trainee identified 72 patients with psychological problems, 46 of whom had new conditions. 133 patients scored over 6 on the 28 item general health questionnaire, 33 of whom were identified as new cases by the general practitioners. 62 patients were seen at follow up, including 23 patients identified by the questionnaire but not by the doctor. The doctors used diagnostic terms to describe the presenting condition in 38 cases. At three month follow up the general health questionnaire scores had fallen by more than 5 points in 22/39 patients identified and managed by doctors and 11/23 identified by the questionnaire. The agreed index of good outcome was almost or completely achieved by 20 of the 39 patients managed by doctors.

Conclusion: Quantifiable methods of evaluating the quality of the structure, process, and outcome of psychological care can be achieved in general practice.