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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
10858 Results
4101
General practitioners' management of mental disorders: a rewarding practice with considerable obstacles
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: BACKGROUND: Primary care improvement is the cornerstone of current reforms. Mental disorders (MDs) are a leading cause of morbidity worldwide and widespread in industrialised countries. MDs are treated mainly in primary care by general practitioners (GPs), even though the latter ability to detect, diagnose, and treat patients with MDs is often considered unsatisfactory. This article examines GPs' management of MDs in an effort to acquire more information regarding means by which GPs deal with MD cases, impact of such cases on their practices, factors that enable or hinder MD management, and patient-management strategies. METHODS: This study employs a mixed-method approach with emphasis on qualitative investigation. Based on a previous survey of 398 GPs in Quebec, Canada, 60 GPs representing a variety of practice settings were selected for further study. A 10-minute-long questionnaire comprising 27 items was administered, and 70-minute-long interviews were conducted. Quantitative (SPSS) and qualitative (NVivo) analyses were performed. RESULTS: At least 20% of GP visits were MD-related. GPs were comfortable managing common MDs, but not serious MDs. GPs' based their treatment of MDs on pharmacotherapy, support therapy, and psycho-education. They used clinical intuition with few clinical tools, and closely followed their patients with MDs. Practice features (salary or hourly fees payment; psycho-social teams on-site; strong informal networks), and GPs' individual characteristics (continuing medical education; exposure and interest in MDs; traits like empathy) favoured MD management. Collaboration with psychologists and psychiatrists was considered key to good MD management. Limited access to specialists, system fragmentation, and underdeveloped group practice and shared-care models were impediments. MD management was seen as burdensome because it required more time, flexibility, and emotional investment. Strategies exist to reduce the burden (one-problem-per-visit rule; longer time slots). GPs found MD practice rewarding as patients were seen as grateful and more complying with medical recommendations compared to other patients, generally leading to positive outcomes. CONCLUSIONS: To improve MD management, this study highlights the importance of extending multidisciplinary GP practice settings with salary or hourly fee payment; access to psychotherapeutic and psychiatric expertise; and case-discussion training involving local networks of GPs and MD specialists that encourage both knowledge transfer and shared care.
Topic(s):
Education & Workforce
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View the DOI record for General practitioners' management of mental disorders: a rewarding practice with considerable obstacles
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View the PubMed citation for General practitioners' management of mental disorders: a rewarding practice with considerable obstacles4102
General practitioners' management of patients with mental health conditions: The views of general practitioners working in rural north-western New South Wales
Type: Journal Article
Year: 2008
Publication Place: Australia
Abstract: OBJECTIVE: To identify the needs of the region's general practitioners concerning diagnosing, treating and referring patients with mental health disorders and major barriers to the general practitioners' management of these patients. DESIGN: Cross-sectional survey. SUBJECTS: All general practitioners working in rural north-western New South Wales. MEASUREMENTS: Self-assessed levels of confidence (5-point Likert scale) in diagnosing and treating patients with a mental health condition. Practice data relating to presentation of such patients as well as issues affecting treatment and referral. RESULTS: The three most commonly diagnosed and treated mental health conditions are depression, anxiety and dementia. General practitioners assessed themselves as being confident in diagnosing and treating these three mental health conditions and in diagnosing and treating adults and the elderly. The only form of treatment intervention that the general practitioners self-assessed as being confident in relates to medication. Referrals to mental health specialists were due mostly to patients needing mental health counselling, the general practitioners seeking clarification of diagnosis as well as having insufficient skills to provide the best possible care. Barriers to being able to refer relate mainly to specialist services not being available and/or accessible as well as patients being reluctant to accept such a referral. CONCLUSION: Our results indicate that other than for depression, anxiety and dementia, efforts to improve the general practitioners' diagnostic and treatment skills and to diagnose and treat adolescents and children are warranted. Up-skilling the general practitioners' ability to confidently use treatment options other than medication are worth considering.
Topic(s):
Education & Workforce
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4103
General practitioners' opinions on their practice in mental health and their collaboration with mental health professionals
Type: Journal Article
Year: 2005
Publication Place: England
Abstract: BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.
Topic(s):
Education & Workforce
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4106
General practitioners' views on drug-assisted rehabilitation
Type: Journal Article
Year: 2012
Publication Place: Norway
Abstract: BACKGROUND: The Norwegian model for opioid maintenance treatment (OMT) "Drug-assisted rehabilitation" (DAR) is a cross-disciplinary tripartite model for the treatment of opioid dependence. The model requires collaboration among GPs, the social services and the specialist health services. To some degree it restricts the doctor's professional autonomy. The investigation aims to examine GPs' attitudes to the model and in particular the experiences of those who have actively participated. MATERIAL AND METHOD: An electronic questionnaire (Questback) was sent to Norwegian GPs listed on the members' register of the Norwegian Medical Association. The respondents were questioned about their general opinions of drug-assisted rehabilitation. Those who had had relevant patients were asked about their experiences and evaluations based on 22 statements. RESULTS: 1,165 doctors (34 % of all registered GPs) responded to the survey. 155 (13 %) were negative, 395 (34 %) neutral, and 604 (53 %) were positive towards drug-assisted rehabilitation. 683 (59 %) were doctors with DAR experience. These were treating approximately 50 % of the country's DAR patients. The tripartite model received significant support. Very few want greater autonomy. The majority also support the strong emphasis on monitoring, although some, particularly older doctors with DAR experience, believe that urine tests could be replaced by personal contact. INTERPRETATION: Drug-assisted rehabilitation was mainly viewed positively by Norwegian GPs in this sample. There was little opposition to the doctor's role in the model, even though it restricts the autonomy of the individual doctor to some degree.
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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View the DOI record for General practitioners' views on drug-assisted rehabilitation
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View the PubMed citation for General practitioners' views on drug-assisted rehabilitation4110
Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: prevalence of painful somatic symptoms, functioning and health status
Type: Journal Article
Year: 2010
Publication Place: Netherlands
Topic(s):
Medically Unexplained Symptoms
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4111
Geographic and specialty distribution of US physicians trained to treat opioid use disorder
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
Opioids & Substance Use
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, Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Geographic and specialty distribution of US physicians trained to treat opioid use disorder
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View the PubMed citation for Geographic and specialty distribution of US physicians trained to treat opioid use disorder4113
Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Education & Workforce
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, Financing & Sustainability
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, Healthcare Disparities
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees
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View the PubMed citation for Geographic Disparities in Availability of Opioid Use Disorder Treatment for Medicaid Enrollees4118
Geographic Variation in the Supply of Selected Behavioral Health Providers
Type: Journal Article
Year: 2018
Abstract: INTRODUCTION: In 2015, an estimated 43.4 million Americans aged 18 and older suffered from a behavioral health issue. Accurate estimates of the number of psychiatrists, psychologists, and psychiatric nurse practitioners are needed as demand for behavioral health care grows. METHODS: The National Plan and Provider Enumeration System National Provider Identifier data (October 2015) was used to examine the supply of psychiatrists, psychologists, and psychiatric nurse practitioners. Providers were classified into three geographic categories based on their practicing county (metropolitan, micropolitan, and non-core). Claritas 2014 U.S. population data were used to calculate provider-to-population ratios for each provider type. Analysis was completed in 2016. RESULTS: Substantial variation exists across Census Divisions in the per capita supply of psychiatrists, psychologists, and psychiatric nurse practitioners. The New England Census Division had the highest per capita supply and the West South Central Census Division had among the lowest supply of all three provider types. Nationally, the per capita supply of these providers was substantially lower in non-metropolitan counties than in metropolitan counties, but Census Division disparities persisted across geographic categories. There was a more than tenfold difference in the percentage of counties lacking a psychiatrist between the New England Census Division (6%) and the West North Central Census Division (69%). Higher percentages of non-metropolitan counties lacked a psychiatrist. CONCLUSIONS: Psychiatrists, psychologists, and psychiatric nurse practitioners are unequally distributed throughout the U.S. Disparities exist across Census Divisions and geographic categories. Understanding this unequal distribution is necessary for developing approaches to improving access to behavioral health services for underserved populations. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
Topic(s):
Education & Workforce
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, Healthcare Disparities
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Reference Links:
View the DOI record for Geographic Variation in the Supply of Selected Behavioral Health Providers
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View the PubMed citation for Geographic Variation in the Supply of Selected Behavioral Health Providers4119
Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone
Type: Journal Article
Year: 2018
Publication Place: United States
Topic(s):
Opioids & Substance Use
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Reference Links:
View the DOI record for Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone
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View the PubMed citation for Geospatial Clustering of Opioid-Related Emergency Medical Services Runs for Public Deployment of Naloxone