Mental health care in the primary care setting: family physicians' perspectives
- PMID: 18556498
- PMCID: PMC2426969
Mental health care in the primary care setting: family physicians' perspectives
Abstract
Objective: To assess family physicians' interactions with mental health professionals (MHPs), their satisfaction with the delivery of mental health care in primary health care settings, and their perceptions of areas for improvement.
Design: Mailed survey.
Setting: Province of Saskatchewan.
Participants: All FPs in Saskatchewan (N = 816) were invited to participate in the study; 31 were later determined to be ineligible because they were specialist physicians, were no longer practising regularly, or could not be located.
Main outcome measures: Family physicians' self-reported satisfaction with and interest in mental health care; perceived strengths and areas for improvement in the quality of mental health care delivery in primary health care settings.
Results: The response rate was 48%, with 375 FPs completing the survey. More than half of the responding FPs (56%) reported seeing 11 or more patients with mental health problems per week. Although 83% of responding FPs were interested or very interested in identifying or treating mental health problems, fewer than half (46%) reported being satisfied with the mental health care they were able to deliver. Family physician satisfaction was significantly higher among those with on-site MHPs (P < .05) and those who saw fewer patients with mental health problems per week (P < .01). The most common mode of interaction that FPs reported having with MHPs was through written correspondence; somewhat less common were telephone and face-to-face interactions. The most common strength FPs identified in their provision of mental health care was having access to psychiatrists, community mental health nurses, and other MHPs. The most common area for improvement in primary mental health care also fell under the category of access. Specifically, FPs felt access to psychiatrists needed to be improved.
Conclusion: Mental health problems are very common in primary care. Most FPs are very interested in the detection and treatment of mental health problems. Despite this high level of interest, however, FPs are generally dissatisfied with the quality of mental health care they are able to provide. Access to MHPs was cited as a critical element in improving the delivery of mental health services in primary care.
OBJECTIF: Examiner les interactions des médecins de famille (MF) avec des professionnels de la santé mentale (PSM), leur satisfaction en regard de la dispensation des soins de santé mentale en contexte de soins primaires et leur opinion sur les points qui nécessitent une amélioration.
TYPE D’ÉTUDE: Enquête postale.
CONTEXTE: La Saskatchewan.
PARTICIPANTS: Les 816 MF de la Saskatchewan ont été invités à participer à l’étude; 31 ont été ensuite écartés parce qu’ils étaient des spécialistes, avaient cessé de pratiquer ou n’avaient pas pu être localisés.
PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Déclarations des médecins concernant leur satisfaction et leur intérêt pour les soins de santé mentale; leur perception des points positifs et de ceux à améliorer dans la qualité des soins de santé mentale dispensés en contexte de soins primaires.
RÉSULTATS: Le taux de réponse était de 48%, 375 MF ayant répondu à l’enquête. Plus de la moitié des répondants (58%) déclaraient voir au moins 11 patients souffrant de problèmes de santé mentale par semaine. Quoique 83% des répondants se soient montrés intéressés ou très intéressés à identifier ou à traiter les problèmes de santé mentale, moins de la moitié (46%) se disaient satisfaits des soins de santé mentale qu’ils pouvaient dispenser. Le niveau de satisfaction était significativement plus élevé chez les MF disposant de PSM localement (P < 0,05) et chez ceux qui voyaient moins de patients avec des problèmes de santé mentale par semaine (P < 0,01). Le mode de communication avec les PSM le plus souvent utilisé par les médecins était la correspondance écrite; les communications téléphoniques et les rencontres individuelles étaient un peu plus rarement utilisées. Le facteur positif le plus souvent cité par les MF à propos des soins de santé mentale qu’ils dispensaient était l’accès à des psychiatres, infirmiers communautaires en santé mentale et autres PSM. Selon les MF, le domaine nécessitant le plus d’améliorations en santé mentale de première ligne était l’accès, plus particulièrement l’accès aux psychiatres.
CONCLUSION: Les problèmes de santé mentale sont très fréquents en médecine de première ligne. La plupart des MF sont très intéressés à identifier et à traiter ces problèmes. Malgré leur haut niveau d’intérêt, les MF se montrent généralement peu satisfaits de la qualité des soins de santé mentale qu’ils peuvent dispenser. L’accès à des PSM a été mentionné comme un élément clé dans l’amélioration des soins de santé mentale dispensés en médecine de première ligne.
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