Roberge Pasquale, Hudon Catherine, Pavilanis Alan, Beaulieu Marie-Claude, Benoit Annie, Brouillet Hélène, Boulianne Isabelle, De Pauw Anna, Frigon Serge, Gaboury Isabelle, Gaudreault Martine, Girard Ariane, Giroux Marie, Grégoire Élyse, Langlois Line, Lemieux Martin, Loignon Christine, Vanasse Alain
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
BMC Fam Pract. 2016 Sep 13;17(1):134. doi: 10.1186/s12875-016-0531-y.
The prevalence of comorbid anxiety and depressive disorders is high among patients with chronic diseases in primary care, and is associated with increased morbidity and mortality rates. The detection and treatment of common mental disorders in patients with chronic diseases can be challenging in the primary care setting. This study aims to explore the perceived needs, barriers and facilitators for the delivery of mental health care for patients with coexisting common mental disorders and chronic diseases in primary care from the clinician and patient perspectives.
In this qualitative descriptive study, we conducted semi-structured interviews with clinicians (family physician, nurse, psychologist, social worker; n = 18) and patients (n = 10) from three primary care clinics in Quebec, Canada. The themes explored included clinician factors (e.g., attitudes, perception of roles, collaboration, management of clinical priorities) and patient factors (e.g., needs, preferences, access to care, communication with health professionals) associated with the delivery of care. Qualitative data analysis was conducted based on an interactive cyclical process of data reduction, data display and conclusion drawing and verification.
Clinician interviews highlighted a number of needs, barriers and enablers in the provision of patient services, which related to inter-professional collaboration, access to psychotherapy, polypharmacy as well as communication and coordination of services within the primary care clinic and the local network. Two specific facilitators associated with optimal mental health care were the broadening of nurses' functions in mental health care and the active integration of consulting psychiatrists. Patients corroborated the issues raised by the clinicians, particularly in the domains of whole-person care, service accessibility and care management.
The results of this project will contribute to the development of quality improvement interventions to increase the uptake of organizational and clinical evidence-based practices for patients with chronic diseases and concurrent common mental disorders, in priority areas including collaborative care, access to psychotherapy and linkages with specialized mental health care.
在初级保健中，慢性病患者共病焦虑和抑郁障碍的患病率很高，且与发病率和死亡率的增加相关。在初级保健环境中，对慢性病患者常见精神障碍的检测和治疗可能具有挑战性。本研究旨在从临床医生和患者的角度，探讨在初级保健中为患有常见精神障碍和慢性病的患者提供精神卫生保健时所感知到的需求、障碍和促进因素。
在这项定性描述性研究中，我们对来自加拿大魁北克省三家初级保健诊所的临床医生（家庭医生、护士、心理学家、社会工作者；n = 18）和患者（n = 10）进行了半结构化访谈。探讨的主题包括与提供护理相关的临床医生因素（如态度、角色认知、协作、临床优先事项管理）和患者因素（如需求、偏好、获得护理的机会、与卫生专业人员的沟通）。基于数据简化、数据展示以及结论得出与验证的交互式循环过程进行定性数据分析。
临床医生访谈突出了在提供患者服务方面的一些需求、障碍和促进因素，这些与跨专业协作、获得心理治疗、多药治疗以及初级保健诊所和当地网络内的服务沟通与协调有关。与最佳精神卫生保健相关的两个特定促进因素是扩大护士在精神卫生保健方面的职能以及咨询精神科医生的积极融入。患者证实了临床医生提出的问题，特别是在全人护理、服务可及性和护理管理领域。
该项目的结果将有助于制定质量改进干预措施，以增加针对患有慢性病和并发常见精神障碍患者的组织和临床循证实践的采用率，优先领域包括协作护理、获得心理治疗以及与专业精神卫生保健的联系。
