1,721,124 research outputs found
The role of the general practitioner in severe mental illness
No full textAround 25–30% of patients with severe and enduring mental illness (SEMI) lose contact with psychiatric services and are looked after entirely in general practice, so it is very important that primary care teams understand their problems and know where to seek help. GPs and practice nurses also have a very important role to play in the physical care of patients with SEMI. High rates of smoking and obesity, and the side-effects of psychotropic drugs, mean that these patients are at increased risk of developing heart disease, chronic obstructive lung disease and diabetes. Mortality rates from cardiovascular and respiratory are more than doubled in schizophrenia. Regular structured assessments of SEMI patients in general practice have been shown to improve the process and outcome of care. Joint GP and nurse assessments probably work best, in special clinical sessions rather than in routine surgery appointments. The National Service Framework for Mental Health recommended that practices produce a register of patients, to ensure that regular reviews are carried out, and including both mental and physical health problems. The new contract for GPs in the UK awards practices money if they produce a register and carry out regular reviews of SEMI patients. Practices can set up registers easily, using repeat prescribing data and other information. Regular reviews should include a check on the accuracy of prescribed medication, a review of physical health, a review of coordination arrangements with secondary care. Special records can be used to keep track of patient reviews for audit purposes. Alternatively, practice computer systems often provide a template for recording regular reviews.<br/
Severe mental illness and the GP Quality and Outcomes Framework
No full textTony Kendrick outlines the rationale for the inclusion of performance targets and indicators for the care of people with severe mental illness in the Quality and Outcomes Framework, and discusses the impact this has had on unplanned hospital admissions for both mental and physical health problems
General practitioner involvement in a group home
No full textThis paper describes the experience of a general practitioner employed to provide physical care to 12 highly dependent residents of a group home. In the first year after their discharge from hospital the residents required a mean of 15 contacts each, 90% of which occurred during regular twice-weekly visits to the home. Previously unmet needs for physical care were identified on screening, including visual, dental and footcare problems which were usually correctable. Smoking and obesity were common and resistant to intervention. Shared care policies are described which were developed together with the nursing staff and visiting mental health professionals
Mild depression in general practice: time for a rethink?
No full textClinical studies, conducted chiefly in hospital settings, have demonstrated that antidepressant drug therapy is effective treatment for major depressive disorder of at least moderate severity, and that cognitive therapy is an effective alternative to antidepressants in mild to moderate major depression. However, few clinical trials have taken place in general practice, where the great majority of patients with depression are managed. Most such patients in this setting do not meet diagnostic criteria for major depression, and are often described more loosely as having 'mild depression'. Many are given an antidepressant, often as the first step in treatment. Here, we consider whether this is the optimal approach for adults with mild depression in general practice
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