Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice

J. Norton, A. O. Engberink, C. Gandubert, K. Ritchie, A. Mann, M. David, D. Capdevielle
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引用次数: 2

Abstract

Objective: Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice. Methods: Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness. Results: 81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies. Conclusion: The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.
保健服务的利用、家庭医生的检出率和法国家庭实践中常见精神障碍患者的管理
目的:提供最新的常见精神障碍(CMD)检出率,并检查自2005年首选医生计划引入法国以来患者的服务使用情况,鼓励患者向他们选择的家庭医生(FP)注册并咨询。方法:对蒙彼利埃地区1133名连续就诊的38名FPs患者进行研究,重复该方案之前进行的研究。候诊室的患者完成了自我报告患者健康问卷(PHQ)和客户服务收据清单,其中包括与首选医生注册和医生购物的问题。CMD定义为达到PHQ标准的抑郁、躯体形式、恐慌或焦虑障碍。对于每位患者,FPs完成了一份精神病例调查问卷。结果:81.2%的患者在调查当天选择了自己的首选医生。在患有CMD的患者中,52.6%被FP检测到。这随着CMD的严重程度和合并症而增加。检测到的病例更有可能咨询他们的首选医生(84.7%对79.4%,未检测到的病例,p = 0.05),而不是其他FP。他们更常去看精神科医生(17.2%对6.7%,p = 0.002)。这与咨询频率或医生购物没有关联,在两项研究中,这两项都有所下降。结论:CMD的检出率相对较高,与我们之前的研究相比没有增加,尽管医生购物率有所下降。一种解释是,在两个时期的调查日,同样高比例的患者访问了他们通常的计划生育,这表明该计划对护理连续性的影响有限。所采取的计划生育行动强调了改进检测对向慢性病患者提供护理的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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