Mental health facilitators in primary care

In the context of the National Primary Care Facilitation Programme, the Sainsbury Centre for Mental Health has reviewed the membership of the Mental Health in Primary Care Network, and explored members' roles; the findings of the review are reported in this article. Researchers examined the activities undertaken by network members, and identified the proportion working directly with primary health care teams and those working strategically within health authorities. Education and training, health promotion, and liaison and linkworking were undertaken by many staff, while a few worked at a more strategic level. In order to increase the effectiveness of this model, a more focused approach is recommended, targeting those with responsibility for implementing changes and developing mental health care in primary care settings. Learning sets which involve primary care and mental health teams, and strategic work with health authorities, are also recommended.     

Epidemiology and primary health care

University departments of epidemiology and primary medical care have tended to develop separately because they require very different skills. The Department of Community Medicine at St. Thomas's Hospital Medical School, London, is an example of a harmonious, combined development of the two disciplines. Working as a multidisciplinary team, the department has conducted studies initiated by epidemiologists, primary physicians and the interaction of the two. Examples are given from past and current research of the department. Through mutual cooperation the scientific knowledge of the epidemiologist and the down-to-earth practical knowledge of the clinician have complemented each other to produce valid research of practical relevance. The association has also provided educational facilities for medical students for whom, as physicians, protocol thinking, analysis and questioning of accepted "facts" will become increasingly important.     

Occupational health through primary health care clinics in Singapore

The training of primary health care workers in occupational health is important for the provision of occupational health care to the workforce. In Singapore, over 400 Designated Factory Doctors, mostly general practitioners, have been trained. Occupational health is also incorporated in the training of family medicine trainees. Referral centres for cases of suspected work-related diseases are also available. Two specialist occupational health clinics function within Government polyclinics serving the large working population in Singapore. One such clinic operates every Wednesday morning at the Jurong Polyclinic. In the last four years, 485 patients with work-related complaints were seen. There were 268 cases (55%) of occupational skin disease, 74 patients (15%) with respiratory complaints, 38 patients (8%) with acute toxic exposures and 36 patients (7%) with musculoskeletal complaints. Three hundred and forty-nine of the referrals (72%) came from the Jurong Polyclinic doctors, with small numbers from other polyclinics and neighbouring private practitioners. The experience gained in conducting this clinic demonstrated that significant numbers of diseases seen at the polyclinic are work-related in varying degrees. Hence, there is a need for the further development of occupational health care delivery within the primary health care system. This can be achieved by improving occupational health training for all primary health care workers, providing an occupational health resource person at primary health care centres, and raising the awareness of such referral facilities in occupational medicine.     

It is past time: Moving psychology into primary health care.

It is past time for psychologists to expand their services into primary health care. For too long, psychological work has been limited to mental health care. Psychology also has much to offer in primary health care. One of my major initiatives during my tenure as president of the American Psychological Association (APA) was to focus on psychologists' contributions to health care in general, particularly on what psychologists are doing to help cancer patients. A great need exists for professional psychologists to expand into these areas. To illustrate the value of psychological interventions in primary health care, I focus on two major health care problems: heart disease and cancer. Both are particularly important areas for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in satisfaction with primary care physicians in a managed care health plan

This study examines whether the formation of satisfaction with primary care physicians in a managed health care plan differs for men and women. Findings indicate that there are significant differences in the formation of satisfaction. For both men and women, the probability that an individual is satisfied is influenced by the type of plan enrolled in, number of problems experienced and beliefs about the quality of and access to benefits. Income and additional insurance coverage affects the probability of satisfaction for women only. Simulation analysis shows how satisfaction changes as individual characteristics and experience with managed care change.     

Automatic data processing in primary health care

Norwegian general practitioners are installing computers in their offices at an increasing rate. More than half of them now run their practice using electronic journals and electronic exchange of information with hospitals, pharmacies etc. There is wide interest among colleagues in the development of new software approaches and packages for running the office. At present, this development is marked by creativity and competitiveness. In fact, Norway has become a market leader within GP-software exporting as far as to Australia. In this article, the seven packages currently available are described by experienced users, and compared from a technical point of view.     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality is associated with perceived health and functional status in older primary care patients.

Using data collected on 265 primary care medical patients 60 years of age and older, the authors examined the personality bases of subjective health (perceived health, functional status) after controlling for observer-rated depression and medical burden. Four hypotheses were tested: High Neuroticism is associated with poorer perceived health, low Extraversion is associated with poorer perceived health, low Openness to Experience is associated with worse functional status, and age moderates the relationships between personality and subjective health. Findings supported the notion that personality is associated with subjective health, moreover, this effect appeared to grow more pronounced with increasing age. This study underscores the conceptual and heuristic value of examining moderators of the links between personality variables and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Profile of a population using a primary health care center in Puerto Rico

PURPOSE: To describe the services delivered by the Family Medicine Physicians at a Community Health Center. METHODS: All information from patient visits during the natural year 1996 were registered using a commercialized computer program. The information was gathered by different means: initial interview, physician's report, records, and personal interviews. RESULTS: A total of 13,203 visits were registered; this represent a total of 4,493 patients. Most of the patients were women, and with a mean age of 38. As expected, most of the patients have Medicaid. The most common conditions seen were hypertension, diabetes, and respiratory diseases. The mean number of visits during the year for almost all conditions was three. Most of the children and adolescents visit the Center due to respiratory conditions, while adults come due to hypertension, diabetes, and musculoskeletal conditions.     

Work satisfaction of health personnel in primary care

OBJECTIVE: To determine the level of work satisfaction of health professionals working in Primary Care and to establish the social, demographic and professional factors which determine it. DESIGN: An observational, crossover study using a self-administered questionnaire. SETTING: Primary Care. PARTICIPANTS: All the doctors and nurses working in the Primary Care teams in the Albacete Health Area (468 in all). MEASUREMENTS AND MAIN RESULTS: The scale of work satisfaction of health professionals in Primary Care teams was used. Social, demographic and professional data were collected. 9 dimensions or components of work satisfaction were identified through a factorial analysis. The lowest scores were for motivation, opportunities for professional development and coordination with specialists. CONCLUSIONS: The findings show, in general, indifference as to work satisfaction or lack of it in areas such as motivation and opportunities for professional development. The differences observed in those polled relate to their job and work-place, and also, in the case of doctors, to specialist training.     

Prevention of cardiovascular disease within the primary health care system--feasibility of a prevention programme within the Sollentuna primary health care catchment area

OBJECTIVE: To integrate prevention of cardiovascular disease within the primary health care. DESIGN: A prevention programme which combines population and individual high-risk strategy. SETTING: The Primary Health Care in Sollentuna, Stockholm, Sweden. MAIN OUTCOME MEASURE: Characteristics of, and risk factor prevalence among, persons registered in the prevention programme. RESULTS: During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15-60 years, were registered in the prevention programme. 90% were < or = 60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol > or = 5.2 mmol/l, and 33% and 22% had a diastolic blood pressure > or = 90 mmHg. CONCLUSION: The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.