Mental health and medical consultation in primary care settings

This paper examines the effect of psychiatric morbidity, as measured by the GHQ-60, on the probability of being in contact with a primary care physician, and the socio-demographic factors which influenced this effect. We found that the presence of psychiatric morbidity emerged as a major determinant of primary care utilization in both sexes, and about one-sixth of consultations in men and one-fifth of consultations in women could be attributed to it. Logistic modelling was used to investigate the joint effect on general practitioner consultation of psychiatric morbidity and seven socio-demographic variables. Sex, age, and psychiatric morbidity exerted independent, but not interactive, effects on consultation.     

Health benefits from a layman intervention in the primary health care

In order to make a necessary life-style change, it is of the utmost importance that a sound motivation is created and the best help a person can get in the process of change is social support. The aim of this study was to locate people having physical symptoms of ill-being and to evaluate the work of a primary prevention programme, especially with regard to health benefits. The sample for the study was made up of 134 consecutive patients who went to see a health care professional because they had subjective complaints. The patients were offered a keep-fit exercise programme, i.e. a layman intervention of an educative-supportive nature, which consisted of ten assignments in a fitness club. The assignments comprised both physical exercise and psychosocial instructions. Two self-rated questionnaires were to be filled in; one at the beginning of the intervention and the other 1 year after its completion. Demographic data focused the attention on a female, manual, middle-aged worker, having symptoms bearing on the musculoskeletal system. The intervention definitely affected the life-style, thus favourably changing physical, psychosocial, and behavioural variables (e.g. increased physical well-being, t-test: P < 0.001; decreased stress, t-test: P < 0.001; increased physical events, t-test: P < 0.01). In plain language, the use of the said intervention can result in the patients taking less time on sick-relief. Therefore, if many more people could be encouraged to take part in intervention programmes, the national medical cost would most likely be reduced. Reflecting upon the result of the study, there is a reason to wish that future intervention programmes be more concerned about the patients' working areas and their leisure time.     

Mental health care in the community: an evaluative study.

A study was designed to assess the therapeutic value of attaching a social worker to a metropolitan group practice in the management of chronic neurotic illness. The psychiatric and social status of a group of patients before treatment and after one year was compared with the status of a control group treated more conventionally over the same period. The results indicate that the experimental service conferred some benefit on the patient population.     

Teenagers' health concerns: implications for primary health care professionals.

Four hundred and eighty five students, aged 13-15 years, at nine comprehensive schools in the London borough of Brent completed a questionnaire about health-related behaviours and health concerns. Among general health concerns, most prominent were weight, acne, nutrition and exercise. There appeared to be a considerable unmet need to discuss sexual development, sexually transmitted diseases and contraception. A substantial proportion (16% of the girls and 3% of the boys) reported sexual abuse, but few wished to discuss this with a doctor or nurse. Although a relatively high percentage of the students smoked and a smaller percentage used alcohol or drugs regularly, there was little concern or interest in discussing these matters with a health professional. Most of the schools did not have a formal health education programme, and in none of them were health professionals available for discussion of the issues under study. There appears to be a need for more comprehensive health education in schools and for primary health care professionals, particularly general practitioners to raise these issues opportunistically with their teenage patients.     

Mental health care training priorities in general practice.

BACKGROUND: Mental health problems constitute a large part of general practitioners' (GPs') work, for which they may have received little training beyond their undergraduate education. They continue to find themselves criticized in the literature over inadequate recognition and management of these problems. While there is concern about the effectiveness of continuing medical education (CME), educational needs assessment can improve the outcome of CME programmes. AIM: To assess GPs' perceived educational needs regarding mental health problems. METHODS: A questionnaire was developed, piloted and posted to GPs (n = 380) in the Lambeth, Southwark and Lewisham Family Health Services Authority (FHSA) area in south-east Thames. In addition to demographic data, the questionnaire asked practitioners to select from a list of 26 mental health topics those in which they would like further training, their preferred educational formats and timetabling, and willingness to attend for training. Two postal reminders were sent to non-respondents. Data were analysed using SPSS. RESULTS: Altogether, 62% (237/380) of the GPs responded. The range for the number of topics selected was from zero to 26 and the mode was 5. Most frequently selected topics were psychiatric emergencies, somatization, counselling skills, 'heartsink' patients, psychosexual problems and stress management, each of which was chosen by at least 40%. Small group work alone, and allied to a lecture, was rated as the most useful educational format. In all, 74% (175/237) indicated that they would be interested in attending a half-day training course. CONCLUSION: These results suggest that GPs working in the inner city recognize the importance of improving their skills in the care of mental health problems, and indicate which topics are regarded as the most important and suitable for educational interventions. A needs-led approach to continuing medical education of this kind will help to plan CME programmes relevant to GPs' needs.     

Establishment of primary health care in Vietnam.

Basic demographic and epidemiological data relevant to health problems in Vietnam are described in this paper. Existing health service arrangements are referred to, with particular emphasis on the strategy for development of primary health care. The establishment of the paediatric centre in Ho Chi Minh City is reported, and examples of its valuable work in primary health care development are described.