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基层医疗中的咨询——全科医生的视角

Counselling in Primary Care – A General Practitioner’s Perspective.

作者信息

Rafferty M, Bradley C

机构信息

Mercy University Hospital, Co. Cork

2. Department of General Practice, University College Cork, Co. Cork

出版信息

Ir Med J. 2019 Feb 14;112(2):869.

Abstract

Introduction Counselling in Primary care (CIPC) is a new service introduced by the HSE in 2013, providing short-term counselling for medical-card holders, suffering from mild to moderate mental health problems. Aims To explore GP’s views on CIPC for the treatment of mild to moderate mental health disorders. Methods Qualitative semi-structured interviews were conducted with GPs who had previously utilized the CIPC service in the Cork/ Kerry region. Forty GPs were identi􀂡ed and sent invitation letters. GPs were purposefully sampled based on criteria of location (urban/rural), gender, practice size (single handed/group) and length of time quali􀂡ed. A total sample size was generated using the ‘ten plus three’ method. Interviews were carried out in person, transcribed verbatim and analyzed using the framework analysis method. Results Nineteen GPs were interviewed. Core themes emerged and were analyzed. 1. GPs unanimously agreed that CIPC has been of bene􀂡t in treating mild to moderate mental health disorders. 2. Suggested improvements to the service were made, including allowing GP visit card holders to avail of the service (n=10) and adolescents aged between 16 and 18 (n=5). 3. A majority (n=12) of GPs interviewed expressed the opinion that a combination of talk therapy and medication was associated with the best outcomes in treating mild to moderate mental health disorders. Conclusion CIPC seems to improve mental health services at a primary care level. While improvements can certainly be made to the service, GPs report positive patient outcomes and a reduction in psychiatric referrals for patients who can be suitably managed within the community.

摘要

引言 初级保健咨询服务(CIPC)是卫生服务执行局(HSE)于2013年推出的一项新服务,为患有轻度至中度心理健康问题的医疗卡持有者提供短期咨询。目的 探讨全科医生(GP)对CIPC治疗轻度至中度心理健康障碍的看法。方法 对科克/凯里地区之前使用过CIPC服务的全科医生进行定性半结构式访谈。确定了40名全科医生并发送了邀请函。根据地点(城市/农村)、性别、诊所规模(单人/团体)和获得资格的时间长短等标准进行有目的抽样。使用“十加三”方法确定总样本量。面对面进行访谈,逐字转录,并使用框架分析法进行分析。结果 对19名全科医生进行了访谈。出现了核心主题并进行了分析。1. 全科医生一致认为CIPC在治疗轻度至中度心理健康障碍方面有益。2. 提出了对该服务的改进建议,包括允许全科医生上门为卡持有者提供服务(n = 10)以及为16至18岁的青少年提供服务(n = 5)。3. 大多数接受访谈的全科医生(n = 12)表示,谈话疗法和药物治疗相结合在治疗轻度至中度心理健康障碍方面效果最佳。结论 CIPC似乎改善了初级保健层面的心理健康服务。虽然该服务肯定可以改进,但全科医生报告称患者有积极的治疗结果,并且对于可以在社区中得到适当管理的患者,精神科转诊有所减少。

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