The integration of comprehensive psychiatric/mental health care into the primary health system: diagnosis and treatment

This research study was funded by the Health Systems Trust in Cape Town through the University of Natal in Durban. OBJECTIVES. The objectives of this study were to teach primary health care nurses to diagnose and treat common psychiatric conditions, to refer those patients whom they cannot handle, and to evaluate the implementation of these functions in their primary health care practice. METHODS. Twenty nurses from six clinics in one province of South Africa were trained, and implementation was studied. History taking, diagnosis, pharmacological treatment and referral were studied through record reviews. Record reviews were done by two independent psychiatrists, who achieved an inter-rater reliability of 0.68. RESULTS. Record reviews showed that at the end of the project nurses could take substantially complete psychiatric histories in 89% cases, five axis diagnoses were correct in 63% of cases, and when STAT medication was prescribed it was appropriate in 92% of cases. Appropriate long-term medication was prescribed in 60% of cases. ETHICAL ISSUES. Permission was obtained from the provincial office, the Municipal Offices and participating clinics. Informed consent was obtained by the registered nurses from all participating clients. LIMITATIONS. The sample for the clinics was not representative of all clinics in the Eastern Cape but a representation of rural-urban settings sampled from 20 clinics in a region. The sample of consumers was convenient and may not represent the client population in each clinic. For this reason the findings may not be a true reflection of the entire region, and generalization of the findings should be made at the utmost discretion of the reader.