Prevalence and management of psychosocial problems in primary care in Flanders - PowerPoint Presentation

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Prevalence and management of psychosocial problems in primary care in Flanders

Lena Vannieuwenborg, Jan De Lepeleire, Frank BuntinxDepartment of General Practice, KU Leuven, BelgiumSlide2

Project DescriptionObjective

To assess the prevalence, presentation and handling of psychosocial problems in primary care in FlandersBackgroundData on prevalence and handling psychosocial problems are widespread and sparse

Shortcoming

of a global picture

Need for a frame that can comprehend the data availableThe question is: what happens in primary care to intercept the psychosocial problems that are presented?Slide3

Methodology (1)Mixed method

‘Fishbone diagram’visualise the main (problem) areas and challengesLiterature studyvarious search engines and (official) databases

medicine, psychology and psychiatry journals

(research) data and/or databases available within the different organizations we approachedSlide4

Methodology (2)Semi-structured

interviewsn = 21 health care and welfare professionals in primary careFocus groupsn = 2 (Nov 2012 and Jan 2013)

Duration approx. 2h

6 and 7 participants respectivelySlide5

Research (sub)questionsMain research questions:

how and how frequently psychosocial problems are presented in primary care?by who (patients) and with whom (care givers)?what what happens in primary care to intercept the

psychosocial

problems that are presented

?what are the results?Split up into 3 areas: presentationhandling/approach

courseSlide6

Key FindingsConceptualisation and inventarisation of psychosocial problems (1)

Uniform definition of the concept of ‘psychosocial problems’?Great dissension and indistinctness in literature and within the practice of the different health care professionals

Construction of our own operational definitionSlide7

Operational definition of psychosocial problems

Psychosocial problems include the broad

spectrum

of everything that is not strictly medical-somatic

. They affect the functioning of the patient in daily life, and concern his environment and/or biography. On the one hand, it concerns different psychological problems

such as

:

feeling anxious/nervous/tense,

(

posttraumatic or

acute) stress,

depression and feeling depressed,

burn out,

loneliness, irritability, sleep disorder, sexual problems,

tics,

alcohol abuse, tobacco abuse, drug abuse, memory problems, behavior problems, learning difficulties, phase of life problems, fear of mental illness, psychoses, schizophrenia, anxiety(disorder), somatization disorder, suicide/suicidality, neurasthenia/surmenage

,

phobia/obsessive compulsive disorder, personality disorder or identity problem, hyperkinetic disorder, intellectual disabilities, relation problems (with friend, family and/or

partner),

medical unexplained symptoms and eating disorders. On the other hand, it concerns different social problems such as: poverty/financial problems, housing problems, problems with food/water, social-cultural problems, problems with work or unemployment, school problems, problems with social security, with health care, legal problems, adjustment problems, loss/death of family/partner and educational problems.Slide8

Key FindingsConceptualisation and inventarisation of psychosocial problems (2)

objective and interpretable data very hard to findEspecially when searching for data on non-medical disciplines

Some possible reasons:

In Belgium,

specific research or registration concerning interventions by (primary care) psychologists virtually absentNature of the data acquisition

(Still) prevailing (self-)stigma

Emotions are not measurable or objectifiableSlide9

Key FindingsPresentation of psychosocial problems

in primary care (1)Integrated (prevalence) data concerning psychosocial problems across the different primary care disciplines are missing

(Research) data are mostly found within the seperate disciplines

Different presentation of the same problem

→ different labeling and/or registration ‘Proto-professionalization’

‘Attributional style’ of patients in regard to their problemsSlide10

Key FindingsPresentation of psychosocial problems in primary care (2)

General practitioner (GP) as a very important gateway to primary careInvolved in 60-80% of the casesIn most cases, GP is first care giver to be consulted

Of these cases, majority remains with GP for follow-up

Data on consultation within the welfare

→ (strong) regional differencesSlide11

Key FindingsHandling of psychosocial problems in primary care (1)

Assistance (still) too much ‘supply-driven’ Data on approach of the (primary care) psychologist- and psychiatrist, social workers and nurses still sparse compared to data on approach of GPNo (official) recognition of the profession of primary care psychologist

Data on the approach of psychiatrists mostly concern secondary care

Data on the approach of social workers are spread and arise from registrations within the seperate branches of authorities

Ways of registration and reporting are not standardizedSlide12

Key FindingsHandling of psychosocial problems in primary care (2)

Drug treatment remains popularAs only treatment, or in combination with non-pharmacological treatmentIn Belgium, the use of psychotropic drugs is frequent and seems to increase even further

Use of tranquillizers and sleep medication seems to remain constant

Increase in prescription of antidepressants ≠ increase in number of (declared) depressionsSlide13

Key FindingsHandling of psychosocial problems in primary care (3)

When it comes to referrals...GP’s help 90% of the patients with psychosocial problemsReferral for psychotherapy is a time asking process, often spread over time

Financial implications can constitute a barrier

When GP’s refer

→ danger of losing sight of patientHaving a psychologist working in the general practice facilitates referrals to them

The process of referral to secondary care sometimes gets stuckSlide14

Key FindingsHandling of psychosocial problems in primary care (4)

Multiculturality asks for different or adapted approachesImportant topic in Belgium

Current care may not be sufficiently and/or appropriately adapted to the differences

Person

of the caregiver important

for effectivity of

treatment

Rather

than discipline-related or bound by theory

Nonspecific elements seem to be of particular importance

consolidation, containement, ‘a place to talk’,...

Demand for a larger and more continuous accessibility of professionals from psychiatry

Especially in

crises

‘Red Phone’

‘Help on the spot’Slide15

Key FindingsCourse of care program / treatment (1)

Need and demand for more multidisciplinary colaborationDue to evolutions in primary and secondary (mental health) care More information exchange between the different authorities and between primary and secondary

care

Experience of limitations and practical considerations in care program by care givers ≠ by care takers

Care givers sometimes experience more barriers than patients

Consequences for further course of treatment

Slower progress, late/slow/no referrals, drug treatment when non-pharmacological help may be more appropriateSlide16

Key FindingsCourse of care program / treatment (2)

Great uncertainty among professionals in primary care about signaling function and -operationalizationFigures virtually untraceable

How professionals can signal psychosocial problems they notice in patients or families?

Financial and digital gap

makes position of the deprived extra weakNot aware of the (different) ways to help, their rights, how to obtain their rights,... Slide17

ConclusionIn (primary care in) Flanders:

No tradition of multidisciplinary research Lack of integrated data on psychosocial problems across different disciplinesDistortion

of (prevalence)

data

Definition of ‘psychosocial problems’?Different labeling (of problems)/(nature of) registration

In case of psychosocial problems:

GP

very important gateway to primary

care

Person of caregiver

important for effective treatment

Great need and demand for

more and better cooperation, communication and coordination

between actors involved in health care and welfareSlide18

Thank you for your attention!