title: Evaluation of the performance of general practitioners in a collaborative care program by employing simulated patients.
abstract: To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients.
  
  
  
  Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs' performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs' plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs.
  
  
  
  There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient-physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder.
  
  
  
  The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient-physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.
authors.affiliation: Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, 13337 95914, Tehran, Iran. aminihom@tums.ac.ir.|Psychosomatic Research Center, Tehran University of Medical Sciences, Tehran, Iran. aminihom@tums.ac.ir.
authors.forename: Homayoun
authors.identifier: 0000-0003-3446-4885
authors.initials: H
authors.lastname: Amini
authors.affiliation: Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Alia
authors.initials: A
authors.lastname: Shakiba
authors.affiliation: Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, 13337 95914, Tehran, Iran.
authors.forename: Vandad
authors.initials: V
authors.lastname: Sharifi
authors.affiliation: Educational Development Center, Tehran University of Medical Sciences, Tehran, Iran.|Departments of LIME and Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mandana
authors.initials: M
authors.lastname: Shirazi
authors.affiliation: Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, 13337 95914, Tehran, Iran.|Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Sadeghi
authors.affiliation: Department of Health Services, National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Abolhasani
authors.affiliation: Faculty of Behavioral Sciences and Mental Health, Mental Health Research Center, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hajebi
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy; D016022:Case-Control Studies; D002983:Clinical Competence; D003299:Cooperative Behavior; D003695:Delivery of Health Care; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D007492:Iran; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000628:therapy; D016544:Patient Simulation; D010817:Physician-Patient Relations; D011570:Psychiatry; D011618:Psychotic Disorders / Q000175:diagnosis / Q000628:therapy; D012017:Referral and Consultation; D059020:Suicidal Ideation
keywords: Community mental health services; Delivery of health care; Mental disorders; Patient simulation