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Randomised controlled trial of teaching general practitioners to carry out structured assessments of their long term
T Kendrick1, T Burns, P Freeling
1St George's Hospital Medical School, London.
Objective:
To assess the impact of teaching general practitioners to carry out structured assessments of their long term mentally ill patients.
Design:
Randomised controlled trial.
Setting:
Sixteen group general practices in South Thames (west) region.
Subjects:
440 adults disabled by long term mental illness.
Interventions:
Patients were identified by using practice data with help from local psychiatric and social services. In eight practices the practitioners were taught a structured assessment schedule to use with patients every six months for two years.
Main Outcome Measures:
Changes in drug treatments, referrals, consultation rates, and recording of preventive health data in the two years after intervention.
Results:
Follow up data were available on 373 patients (84.7%). At least one structured assessment was recorded for 127 patients in the intervention group but only 29 had four assessments recorded. Participating practitioners considered the structured assessment to be time consuming and reported that it did not often lead directly to changes in treatment or referrals. Changes in treatment with neuroleptic drugs and referrals to community psychiatric nurses, however, were significantly more frequent in the intervention group (differences for intervention group minus control group adjusted for activity in two years before intervention were 14.3% (95% confidence interval 4.3% to 24.33%; P < 0.01) for neuroleptic drugs and 13.3% (2.0% to 24.6%; P < 0.05) for referrals). There were no significant differences in psychiatric admissions, use of the Mental Health Act, drug overdoses, prescriptions, referrals or admissions for physical problems, consultation rates, continuity of care, or recording of preventive data.
Conclusions:
Teaching general practitioners about the problems of long term mentally ill patients may increase their involvement in patients' psychiatric care. Regular structured assessments do not seem feasible in routine surgery appointments. More training for general practitioners and increased resources such as more nurse time may be necessary if improvements in care of long term mentally ill patients in general practice are to be generalised.