title: Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice.
abstract: Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice.
  
  
  
  Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness.
  
  
  
  81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies.
  
  
  
  The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.
authors.affiliation: 1 Inserm, U1061, University of Montpellier, Montpellier, France.
authors.forename: Joanna
authors.initials: J
authors.lastname: Norton
authors.affiliation: 2 Department of General Practice, University of Montpellier, France.
authors.forename: Agnès Oude
authors.initials: AO
authors.lastname: Engberink
authors.affiliation: 1 Inserm, U1061, University of Montpellier, Montpellier, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gandubert
authors.affiliation: 1 Inserm, U1061, University of Montpellier, Montpellier, France.|3 Center for Clinical Brain Sciences, University of Edinburgh, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
authors.affiliation: 4 Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mann
authors.affiliation: 2 Department of General Practice, University of Montpellier, France.
authors.forename: Michel
authors.initials: M
authors.lastname: David
authors.affiliation: 1 Inserm, U1061, University of Montpellier, Montpellier, France.|5 University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Capdevielle
mesh_terms: D000328:Adult; D000368:Aged; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D058005:General Practitioners / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: common mental disorders; detection; family practice; service use