Psychiatrists role in primary health care in Greece: findings from a quantitative study

Abstract

BackgroundAlthough the need for integration of mental health services into primary care is well established little has been done. The outbreak of the recession found the Greek mental health system in transition. As a response to the crisis, governments implemented horizontal budget cuts instead of health reforms. This resulted in an unfavorable situation for mental health which was set once again on the sidelines of the health policy agenda. Previous studies suggest that the most prevalent disorders in the years of financial crisis in Greece are depression and anxiety while a general increase of the psychiatric morbidity is observed does not follow the population’ needs.MethodsThe present descriptive study was carried out between March and June of 2015. A convenience sample of 174 psychiatrists and psychiatry residents who met the inclusion criteria were finally selected to participate. Data were collected by using a 40-items questionnaire consisted of three sections: (a) nine questions about demographics, (b) nine questions pertaining to general aspects of administrative regulations related to primary care, (c) 22 questions about psychiatrists attitudes and perceptions towards their role in primary care. Quantitative variables are expressed as mean values, while qualitative variables as absolute and relative frequencies.ResultsThe vast majority of participants perceives the public primary care services and mental health services in their community as inadequate and considers psychiatrists’ participation in primary care as important in order to improve the detection and management rates of people demonstrating mental health symptoms. They also believe that: (a) primary care practitioners’ usually fail to detect the mental health conditions of patients; (b) their participation in primary care will decrease the social stigmatization for mental health conditions; (c) patients receiving pharmaceutical treatment for mental health problems by GPs and other primary care professionals usually fail to comply.ConclusionsRespondents in the present study are receptive to participate in primary care. They believe that their inclusion to primary care will result to decreased social stigmatization for mental health problems, increased patient’ access and improved detection and management rates for common mental health conditions.

Prevalence of use of on-label and off-label psychotropics in the Greek pediatric population

“…In this way we cannot know how many diagnosed patients in need of medication exist in Greece, nor whether the current situation reflects appropriate use, underuse or overuse of psychotropics. In addition, access to mental care may be limited in certain areas mostly due to financial and geographical reasons: attention of patients by mental health specialists is easier in big urban areas but harder otherwise, with a need to move between regions to access specialists; thus, patients may remain undiagnosed and subsequently untreated ( Souliotis et al, 2017 ). Another problem identified in the Greek community is the high stigma on mental health diseases ( Tzouvara et al, 2016 ).…”

General practitioners’ views towards management of common mental health disorders: Τhe critical role of continuing medical education

“…Close collaboration with mental health specialists, in both training and practice, is of eminent importance. In order to guide an efficient support of mental disorders at the primary healthcare, the following recommendations are deduced from this study, also supported by the literature: i) theoretical learning should be accompanied by practical training, so that education is tied with real clinical practice [ 4 ], ii) an efficient model of outpatient consult liaison psychiatry, like the collaborative care model [ 31 , 32 ] should be developed, that enhances the skills of GPs to manage psychiatric patients, and iii) adequate time for diagnosis, counselling, self-study and consultation should be given to GPs, along with incentives to be deeply involved in the management of mental disorders [ 4 , 7 , 15 , 22 , 33 ].…”

“…The level of education is reflected on correct diagnosis and successful treatment of CMDs and increases GPs' self-confidence. These are highly significant in a country, like Greece, which has suffered from an continuing financial crisis leading to high unemployment rates and social inequalities, in addition to fragmented health services which missed the chance to be fully reformed into a more community-oriented mental health system due to the recession, during the last years [ 32 ]. Recently, it has been reported that Greek psychiatry is developing in the right direction; however the public system of mental healthcare needs economic and organizational support, in order to complete the discontinued psychiatric reform [ 34 ].…”

“…Integral to this, the GPs' reported prevalence of CMDs reflects the rate of mental disorders' detection by them, rather than the true occurrence, assessed by specialists. In addition, there are factors that were not evaluated in this study, namely GPs' perceived role, limited time and level of discomfort in managing mentally ill persons [ 15 , 32 ]. While the limited time that a GP can spend with a patient has been reported as an obstacle in almost all countries [ 20 – 22 , 32 , 33 ] and necessitates a healthcare system reform, the other two factors could be faced through CME [ 20 ].…”

Community Mental Health Services in Greece: Development, Challenges and Future Directions

“…2,3 As a result, most large hospitals and asylums have этих служб в соответствии с возникающими потребностями. Принципиальным аспектом является то, что данные цели требуют внедрения стандартов клинической практики и последовательного перехода от традиционной терапии к личностно-ориентированной психиатрии и профилактике психических расстройств.…”