General practice meeting the needs for psychiatric care in Croatia

In recent decades, general practitioners (GPs) have become critical components of mental health services. However, in Croatia the role of GPs in mental health services is still mostly perceived as "gate keeping", whereas seeking help for serious mental illnesses is mostly restricted to psychiatrists. The aim of this study is to investigate the practices and attitudes of family doctors in providing care for psychiatric patients.

The study included 111 GPs, working in 38 different locations in four major towns in Croatia. Data were collected using a questionnaire, specifically designed for the purpose of this study.

By their own estimation, GPs prescribed antidepressants without a psychiatrist's recommendation in about 37% of patients who use them. Also, GPs prescribed sedatives without a psychiatrist's recommendation in about 60% of patients who use them. Although certain categories of psychiatric patients (elderly, patients with PTSD) were almost always referred to a psychiatrist, it was GPs' attitudes toward psychiatric casualties and their proneness to prescribe antidepressants and sedatives without a psychiatrist's recommendation that predicted whether a patient will be treated by himself of referred to a psychiatrist. "Interest/Competency" and "Knowledge" of the GPs positively correlated with the number of courses attended as a part of continuous medical education (CME).

Overall, the role of GPs in mental health services in Croatia is changing into a more active one, as a significant portion of patients with depression and anxiety are being treated by GPs. Personal interest and self confidence in proper knowledge and skills, in part acquired also from current CME programs, are determinants of higher autonomy of GPs in treating psychiatric patients. Psychiatrists, as active promoters of community mental health should more actively encourage their alliance with GPs, especially through offering higher quality CME courses.