Évaluation des échanges professionnels entre médecins généralistes et psychiatres

Abstract

Objectives

There is in France a higher prevalence of psychiatric disorders and higher than average psychotropic consumption in the general population. Considering these elements and the need to involve two complementary medical specialities to manage these disorders, general practice and psychiatry, the necessity for optimal professional exchanges is a major public health concern. In the French public health system, primary care is overseen by self-employed general practitioners. The French psychiatric public sector is said to be “sectorised”, i.e. organised in specific sectors. These sectors include in-patient care entities and out-patient services. The private sector in psychiatry is not sectorised and is mainly composed of self-employed psychiatrists and private clinics. A 2004 law designed to govern who is authorized to refer patients to specialists, stipulated that general practitioners were the only authorized referring doctors for primary care. In the meantime, the number of general practitioners being consulted for cases of depression has doubled between 2005 and 2010. Less than a quarter of these patients were referred to a psychiatrist. Our main objective is to assess the satisfaction with and the efficiency of exchanges between psychiatrists and general practitioners. We also endeavour to identify the main channels through which collaborative care involving these two specialists can be improved.

Materials and methods

Our work is an observational, transverse, monocentric and descriptive study carried out using analogous feedback forms mailed by post from June to September 2016. The feedback forms were designed to be analysed both separately and comparatively. Two hundred and ninety nine self-employed general practitioners and 46 psychiatrists employed in the public sector returned the forms. The psychiatric private sector was excluded. All of these doctors worked within three specific geographical treatment zones: Saint-Étienne, Ondaine and Pays de Gier (350,000 inhabitants). The results were treated anonymously via Microsoft Excel® and IBM Corporation SPSS Statistics®. This study was approved by the ethics committee of the university hospital center (CHU) of Saint-Étienne. The doctors’ registers were retrieved via the databases of the Departmental Council of Doctors (CDOM) of the Loire and that of the CHU of Saint-Étienne.

Results

One hundred and twenty four general practitioners and 30 psychiatrists responded to the feedback form completely. Response rates were 41.4 % for the family physicians and 65.2 % for the psychiatrists. Respectively, 57 % and 70 % knew the identity of their counterpart. A public sector psychiatrist saw 91.9 % of the patients also treated by general practitioners. Of the attending doctors, 79.8 % reported a one third or less return rate of follow-up information from the psychiatrist for the patients they treated together. Similarly, 76.7 % of the psychiatrists reported a return rate of one third or less. One hundred percent (p < 0.05) of the general practitioners who did not know the psychiatrists were dissatisfied with their collaboration. Likewise, 98.9% (p < 0.05) of the general practitioners who rarely or never received correspondence from the psychiatrists were dissatisfied. Respectively, 77.7% (p > 0.05) and 69.5% (p > 0.05) of the psychiatrists were dissatisfied. In favor of participating in a standard addressing and return letter process, were 53.4% of the psychiatrists. On the contrary, 64.9% of the general practitioners were against such a process. Willing to receive additional medical training in the psychiatric field were 74.5 % of the family physicians. One out of five psychiatrists considered it a high priority for general practitioners to receive additional training in the psychiatric field. Sharing hospitalisation and consultation reports, along with general practitioners continuous medical training, were considered to be the top priorities for any approach for improving communication.

Conclusions

We observed a high level of dissatisfaction among the participants as a result of the lack of communication. As mentioned above, the field of psychiatry is compartmentalised, psychiatrists are less available for general practitioners. General practitioners are not sufficiently trained but are willing to take more training to improve their practice in the psychiatric field. The results of this study show that first and foremost there is a need to systematise mailings, to simplify phone-based opinion sharing, and to increase the frequency of cross-field training among general practitioners. All of the above could improve exchanges and the management of patients suffering from psychiatric disorders.