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Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/928129
- Patient characteristics in GP referrals to the better outcomes in mental health care ATAPS program: a case-control study
Maddock, Gillian R.
- University of Newcastle. Faculty of Science and Information Technology, School of Psychology
- Professional Doctorate - Doctor of Clinical Psychology (DCP)
- Background: The National Survey of Mental Health and Wellbeing (Andrews, Hall, Teeson, & Henderson, 1999) was the first Australian epidemiological study providing population estimates for the prevalence of mental health disorders, associated disability and mental health service use and unmet need for mental health care. Subsequently, the rates and types of mental health disorders presenting to primary care were identified through General Practice audits (the BEACH studies) (Britt et al., 2010). Furthermore, the Australian General Practice depression screening program (SPHERE: a national depression project) (Hickie, Davenport , Naismith, & Scott, 2001) illuminated the high prevalence of mental disorders in General Practice and unmet need for mental health care. Mental illness continues to be a leading cause of morbidity, accounting for 13% of Australia’s burden of illness (Australian Institute of Health and Welfare, 2010a), with around 20% of the Australian adult population experiencing clinically relevant symptoms of mental disorder each year (Australian Institute of Health and Welfare, 2010b). It has been widely recognised that General Practitioners (GPs) play a pivotal role in the recognition and treatment of mental illness (Hickie & Groom, 2002) and that mental disorders in General Practice are common; Around 50% of patients have mental illness (Hickie, Davenport, Naismith & Scott, 2001). Despite this, GPs have encountered barriers accessing quality mental health care for their patients. The Australian Commonwealth Government introduced the Better Outcomes in Mental Health Care (BOiMHC) Access to Allied Psychological Services (ATAPS) program in 2003 to increase access to mental health care. Guidelines for these programs stipulated that evidence based non-pharmacological mental health care should be provided by suitably qualified allied health professionals, for a population of General Practice patients with recent onset, mild to moderate mental health disorders, who were unable to afford private mental health services. New services should be evaluated so that service delivery and clinical outcomes are optimised. National evaluations revealed the uptake of the ATAPS program was considerably greater than had been expected and that patient characteristics are generally consistent with stipulated guidelines. This thesis seeks to explore the issue of how GPs select patients for referral to ATAPS from within the population of patients attending primary care who are known to have high frequency of mental illness and related disability. The specific question to be answered is: which patient characteristics identify referrals to ATAPS (cases) compared to General Practice patients (controls)? Method: A case-control design was used at a Division of General Practice; 63 cases (ATAPS patients), and 64 controls (general practice patients never referred to ATAPS). Unadjusted and sequentially adjusted logistic regressions were used to identify independent predictors of being an ATAPS case based on official referral guidelines: ICD-10 diagnosis of mental illness (depression or anxiety) and scores on the K-10 (psychological distress) and DASS-21 (psychological symptoms). A forward stepwise multivariable logistic regression was also used to determine the best minimum set of predictor variables. Results: In unadjusted models, Any Mood Disorder, OR 7.68, (95%CI: 3.47, 17.01), Any Anxiety Disorder, OR 2.88, (95%CI: 1.37, 6.05), higher K-10 score, OR 1.06 (95%CI: 1.04, 1.14) and higher DASS-21 score, OR 1.06, (95%CI: 1.03, 1.09), were each significantly associated with being a case. Any Mood Disorder, Any Anxiety Disorder, K-10 score and DASS-21 scores remained significant in most adjusted analyses, although all models showed change when adjusted for mental disability and physical disability. Three variables predicted cases in the multivariable regression: greater mental (psychiatric) disability lesser physical disability and greater number of substances misused in the past 3 months. Conclusion: GPs generally selected cases in keeping with the ATAPS referral guidelines. Cases selected had higher levels of mental disability and greater substance misuse, whereas GPs were less likely to select cases with greater levels of physical disability.
Access to Allied Psychological Services;
primary mental health care;
- Resource Type
- Copyright 2012 Gillian R. Maddock