Frequency of consultations and general practitioner recognition of psychological symptoms.
BACKGROUND
General practitioners (GPs) are widely reported to 'miss' half of the psychological problems present in their patients.


OBJECTIVE
To describe the relationship between frequency of consultations and GP recognition of psychological symptoms.


METHODS
Survey of GPs and their patients.


METHODS
General practices in the southern part of New Zealand's North Island.


METHODS
Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a sub-set of 386 form the basis of this study). The main measure was the comparison between GP and composite international diagnostic interview (CIDI) recognition of psychological problems.


RESULTS
Of the GPs selected, 90% participated. The CIDI was completed by 70% of selected patients. In patients (n = 386) with a CIDI-diagnosed disorder, 63.7% (95% confidence interval [CI] = 53.3 to 74.1) were considered by the GP to have had psychological symptoms in the last year; 40.1% (CI = 31.0 to 49.2) to have had clinically significant psychological problems, and 33.8% (CI = 24.9 to 42.6) were given an explicit diagnosis. However, in those CIDI-diagnosed patients who had been seen five or more times during the previous year, these recognition figures increased to 80.2% (CI = 68.9 to 91.4), 59.4% (CI = 45.9 to 72.9) and 53.6% (CI = 40.1 to 67.1) respectively, and dropped to 28.8% (CI = 13.0 to 44.7), 13.6% (CI = 3.4 to 23.7), and 10.7% (CI = 1.4 to 19.9) among patients not consulting during the previous year. GPs often differed from the CIDI in their assessment of clinical significance and diagnosis.


CONCLUSIONS
GP non-recognition of psychological problems was at a problematic level only among patients with little recent contact with the GP. Efforts to improve GP recognition of mental disorder may be more effective if they target new or infrequent attenders, and encourage patient disclosure of psychological issues.
Bushnell
John
J
University of Otago, Wellington School of Medicine and Health Sciences, New Zealand.
D003266:Continuity of Patient Care; D005194:Family Practice / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*
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