title: Role of the general practitioner in the care of patients recently discharged from the hospital after a first psychotic episode: influence of length of stay.
abstract: OBJECTIVE
  It is unclear to what extent general practitioners are involved in the postdischarge care of patients hospitalized for a first psychotic episode and whether this involvement is influenced by length of stay in the hospital. The objectives of this study were to describe the role of the general practitioner in providing postdischarge care to patients with first-episode psychosis in terms of frequency and type of consultation and the extent of collaboration with hospital-based specialist services and to determine whether decreasing length of stay was accompanied by a modification in this role.
  
  
  METHODS
  Six months after hospital discharge, a postal questionnaire was sent to the general practitioners of patients recruited to the French STEP cohort (Schizophrenie et son Traitement: une Evaluation de la Prize en charge), a prospective study of the clinical and social determinants of care pathways and prognosis for patients hospitalized for a first psychotic episode (DSM-IV criteria) in 5 services of the La Colombière Psychiatric Hospital, Montpellier, France. Length of stay in the hospital was dichotomized according to the median value of 35 days. Data collection took place from February 2008 to March 2009.
  
  
  RESULTS
  Of the 121 STEP patients, 65% (n=79) had a regular general practitioner. The general practitioners had been informed by the hospital of the admission of their patient in only 17.9% (7/39) of cases. Of the general practitioners, 78.3% (47/60) had seen the patient at least once since discharge, with a median number of visits standardized over 6 months of 0.86 (range, 0-8.6). General practitioners were better informed with regard to diagnosis, date of discharge, name of psychiatrist, treatment, and community follow-up at discharge for patients with a short length of stay in the hospital, who were also more likely than those with a long length of stay to be consulting for mental health problems.
  
  
  CONCLUSIONS
  Our findings suggest a low level of implication of general practitioners in providing postdischarge care to first-episode psychotic patients, irrespective of their length of hospital stay. Yet, the general practitioner has a role to play in coordinating and providing care for somatic health problems as well as psychiatric symptoms, specifically in the case of early discharge.
authors.affiliation: INSERM, U1061, University of Montpellier 1, Montpellier, France.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Norton
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Rivoiron-Besset
authors.forename: Michel
authors.initials: M
authors.lastname: David
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.forename: Cindy
authors.initials: C
authors.lastname: Prudhomme
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Boulenger
authors.forename: Anthony H
authors.initials: AH
authors.lastname: Mann
authors.forename: Karen A
authors.initials: KA
authors.lastname: Ritchie
authors.forename: Delphine
authors.initials: D
authors.lastname: Capdevielle