Procome, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, SE-171 77, Stockholm, Sweden.
Swedish Agency for Health Technology Assessment and Social Assessment, SE-102 33, Stockholm, Sweden.
BMC Fam Pract. 2019 Aug 19;20(1):117. doi: 10.1186/s12875-019-1007-7.
Depression and anxiety disorders are common in primary care. Comorbidities are frequent, and the diagnoses can be difficult. The Mini-International Neuropsychiatric Interview (MINI) can be a support in the clinical examination of patients with complex problems. However, for family practitioners (FPs), time and perceptions about structured interviews can be barriers to the MINI. An inter-professional teamwork process where FPs refer a patient to a therapist for a MINI assessment represents one way in which to address the problem. The results are fed back to the FPs for diagnosis and treatment decisions. The purposes of this study were to explore if the process was feasible for FPs, patients and therapists in Swedish primary care, and to identify factors influencing the process, using the COM-B model.
FPs at two primary care centers (PHCC) in Stockholm were offered the opportunity to refer patients to in-house therapists. Semi-structured interviews or focus groups were conducted with 22 patients, 17 FPs and three therapists to capture their experiences and perceptions. Inductive content analysis for each group of participants was followed by triangulation across groups. Finally, the categories obtained were fitted to the components in the COM-B.
Therapists at both PHCCs conducted the MINI. The intended process was adopted at one PHCC. At the second PHCC, the responsibilities for the diagnosis and treatment of patients referred were transferred to the therapist. The patients were satisfied, as they appreciated multi-professional examinations. The FPs' competence in psychiatry, actual access to therapists, beliefs that the referrals saved the FPs time and effort, and established habits influenced whether patients were referred. Existing routines and professional expectations for work content influenced the degree of cooperation between the therapists and the FPs.
An inter-professional diagnostic process where FPs refer patients to a therapist for assessment and the results are fed back to the FPs can be feasible. Feasibility depends on access to a therapist, the perceptions of roles and competences among FPs and therapists, and strategies for supporting teamwork.
抑郁和焦虑障碍在初级保健中很常见。共病很常见，诊断也很困难。迷你国际神经精神访谈（MINI）可以为有复杂问题的患者的临床检查提供支持。然而，对于家庭医生（FPs）来说，时间和对结构化访谈的看法可能是使用 MINI 的障碍。家庭医生将患者转介给治疗师进行 MINI 评估的跨专业团队合作过程是解决该问题的一种方法。结果反馈给家庭医生进行诊断和治疗决策。本研究的目的是探讨该过程在瑞典初级保健中对家庭医生、患者和治疗师是否可行，并使用 COM-B 模型确定影响该过程的因素。
斯德哥尔摩的两家初级保健中心（PHCC）的家庭医生有机会将患者转介给内部治疗师。对 22 名患者、17 名家庭医生和 3 名治疗师进行了半结构化访谈或焦点小组讨论，以了解他们的经验和看法。对每组参与者进行了归纳内容分析，然后对各组进行了三角测量。最后，获得的类别被拟合到 COM-B 的组件中。
两家 PHCC 的治疗师都进行了 MINI。一个 PHCC 采用了预期的过程。在第二个 PHCC，对转介患者的诊断和治疗的责任转移给了治疗师。患者感到满意，因为他们欣赏多专业检查。家庭医生在精神病学方面的能力、实际获得治疗师的机会、认为转诊为家庭医生节省了时间和精力的信念，以及既定的习惯，都影响了患者是否被转介。现有的常规和对工作内容的专业期望影响了治疗师和家庭医生之间的合作程度。
家庭医生将患者转介给治疗师进行评估，然后将结果反馈给家庭医生的跨专业诊断过程是可行的。可行性取决于治疗师的可及性、家庭医生和治疗师之间对角色和能力的看法，以及支持团队合作的策略。
