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Biomedical subjects

L Gask

Publications and source records attributed to L Gask.

At least 19 recordsLinked to original sources
PubMed1999

Psychiatric training for family doctors: what do GP registrars want and can a brief course provide this?

CONTEXT: About 40% of British General Practitioners (GPs) train formally in a psychiatric post as part of their general practice training, but such training may not fully meet the needs of future GPs. A specific course in psychiatry for family doctors has run in Manchester for more than a decade. METHOD: Semi-structured interviews conducted with GP registrars before attending the Manchester course in psychiatry with questionnaire follow-up afterwards to ascertain (a) the training 'wants' of GP registrars and (b) whether the course was providing them. RESULTS: GP registrars most frequently wanted training in communication skills, how to access the resources that are available to GPs, the detection of psychiatric illness, drug treatment and the management of aggression. The course was successful in satisfying the first three but failed in the last two. There was trend for those who attended Manchester Medical School, which scored significantly higher on number of topics covered at undergraduate level, to perceive a greater need for training than those who attended other medical schools. However, there was no evidence to link self-perception of greater need with having already worked in general practice during postgraduate training. CONCLUSIONS: More attention needs to be paid to how to address the specific mental health skills training requirements of GP registrars both within the attachment in psychiatry and during the practice year. Preliminary research is required to devise teaching packages before they are entirely satisfactory for GP education.

Education, Medical, Continuing↗
PubMed1999

Impact of a national campaign on GP education: an evaluation of the Defeat Depression Campaign.

BACKGROUND: The Defeat Depression Campaign, which was run by the Royal College of Psychiatrists and the Royal College of General Practitioners (RCGP) from 1992 to 1996, aimed to educate general practitioners (GPs) to recognize and manage depression. AIM: To measure the educational impact on GPs of the Defeat Depression Campaign. METHOD: A postal survey using a structured questionnaire was distributed to 2046 GPs obtained by systematically sampling 1 in 14 GPs from alphabetical lists from family health services authorities (FHSAs) in England and Wales. The questionnaire covered awareness of the campaign, awareness and use of campaign materials, and ratings of the usefulness of the campaign in relation to other educational activities. RESULTS: Two-thirds of GPs were aware of the campaign and 40% had definitely or possibly made changes in practice as a result of it. Impact of materials was highest for a consensus statement on the recognition and management of depression in general practice and for guidelines derived from it, each of which had been read in detail by about one quarter of responders and was known of by an additional one third. Impact was low for the other materials. The campaign had the highest impact among younger GPs, members of the RCGP, and (less strongly) among those who had undertaken a six-month post in psychiatry, those who were working in larger practices and fundholding practices, and women; 56% of GPs had attended a teaching session on depression in the past three years. CONCLUSION: A national campaign of this kind can have a useful impact, but it needs to be supplemented by local and practice-based teaching activities.

Adult↗
PubMed1998

Mental health. Past tense--future imperfect.

Experience from total purchasing sites suggests that commissioning mental health services in primary care will be difficult to achieve. Health authorities and trusts are concerned about maintaining adequate services for severely mentally ill people, who are rarely the focus of primary care innovations. Conflict between the competing priorities of primary and secondary services seems likely to remain. Evidence from total purchasing sites suggests it is more difficult to bring about change in mental healthcare than other services.

Budgets↗
PubMed1998

Clinical factors associated with short-term changes in outcome of patients with somatized mental disorder in primary care.

BACKGROUND: There is little research that examines demographic, clinical and treatment factors associated with changes in physical symptoms, psychiatric symptoms and functional outcome in patients with somatized depression or anxiety in primary care. METHOD: Factors associated with the outcome of psychologized or somatized depression or anxiety were derived from the literature. These factors were tested individually for their effects on changes in physical symptoms, psychiatric symptoms and functional outcome between baseline consultation with the general practitioner and 1 or 3 months later in 215 patients with somatized depression or anxiety. Individual factors associated with a particular outcome, demographic, DSM-IV diagnosis and treatment variables were entered into a multiple regression analysis. RESULTS: Factors associated with a better outcome on all three types of outcome measure were the absence of generalized anxiety disorder and/or simple or social phobias, absence of physical pathology, and the prescription of fewer drugs, especially hypnotics or benzodiazepines. In addition, a better psychiatric symptom outcome was associated with the patients' perceived satisfaction with the general practitioner's understanding or explanation of the patient's problems. A better functional outcome was associated with having a job, less distress over physical symptoms, not receiving invalidity benefit and no referral to hospital. CONCLUSION: There are clinical and demographic factors associated with all types of short-term outcome in patients with somatized depression or anxiety but there are additional factors that are associated only with either psychiatric or functional outcome.

Adaptation, Psychological↗
PubMed1998

Evaluation of a training package in the assessment and management of depression in primary care.

This study aimed to evaluate the impact on the behaviour and attitudes of experienced general practitioners of a 10-hour training package in the assessment and management of depression. Twenty general practitioners participated. Both subjective and objective assessments were carried out which suggested significant improvements in both assessment and management skills. However, subjectively reported changes were not always supported by the objective data obtained from rating role-played interviews. The role-played patients rated the doctors as better communicators after training. All participants felt attending the course was beneficial. They all felt more confident in their abilities to deal with depression and said the skills they had learnt on the course would be useful to them in their future work. An outcome study is now underway in order to assess whether the training package, which has been demonstrated to have an impact on the behaviour, skills and attitudes of doctors, has an impact on the health of patients.

Adult↗
PubMed1998

Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs.

BACKGROUND: Patients with mental disorder presenting with medically unexplained symptoms (somatized mental disorder) are difficult to treat and consume a lot of health care. OBJECTIVES: The aim of the study was to examine the cost-effectiveness of a training package for somatized mental disorder delivered by GPs. METHODS: The study design was a prospective, before- and after-training study of different cohorts of patients attending eight GPs, acting as their own controls. Cost-effectiveness analysis was estimated using changes in case level on a self-rated psychiatric symptom questionnaire (GHQ-12) and direct health costs between the index consultation and 3 months later. RESULTS: There were 103 and 112 patients with somatized mental disorder in the before and after training cohorts, respectively. After training, costs of referrals outside the primary care team decreased significantly by 23%, with little overall change in primary care costs. Total direct health care costs, including training, were reduced by 15%. After training, an extra 17 patients were successfully treated (no longer GHQ-12 cases) at 3 months. The marginal cost-effectiveness per extra successfully treated patient was pound sterling 325 and the cost per successfully treated case was 69% of the cost of the GP's usual treatment. CONCLUSIONS: Training GPs with the reattribution training package appears to be extremely cost-effective.

Cost-Benefit Analysis↗
PubMed1998

Small group interactive techniques utilizing videofeedback.

OBJECTIVE: Development and evaluation of a method of training primary care providers in psychiatric skills which utilizes videofeedback of real and role-played consultations in a group setting. METHOD: The development of the basic training approach and additional material for teaching specific skills is described. Evaluation has addressed the impact of training on 1) clinician behavior and 2) measures of outcome. RESULTS: Research over a number of years has demonstrated an impact on clinician behavior with some evidence of impact on clinical and economic measures and patient satisfaction. CONCLUSIONS: Videofeedback training appears to be most effective when it is provided with a clear model for the professional-patient interaction. Its effectiveness can be further enhanced by delineating sets of component microskills that can be learned using a combination of videotape modeling, role-play, and feedback. Challenges for future research include investment in randomized controlled trials for outcome, developing the training approach for a range of primary care workers, training sufficient group facilitators, and achieving widespread dissemination without subsequent dilution of effectiveness.

Clinical Competence↗
PubMed1997

Emotional problems in primary care: what is the potential for increasing the role of nurses?

It has been suggested that the role of primary care and community nurses should be expanded in relation to mental health in order to assist in the prevention and management of prevalent emotional disorders such as depression and anxiety. However, relatively little is known about the mental health work presently undertaken by these nurses. Furthermore, nurses' training needs, attitudes and organizational barriers to role expansion in this area have not been systematically explored. This article seeks to review the literature on nurses' potential and current mental health work, current and future training needs, the views of patients and nurses concerning an expanded nursing role, and organizational issues of relevance. Educational interventions which have been systematically evaluated are also reviewed. The results suggest that nurses are already involved in emotional health care with a variety of patient groups, although this is not always acknowledged as mental health work. While clear potential for an expanded role exists, there is little consensus as to what role would be most effective for each nursing group, and few educational interventions have been demonstrated to be of proven effectiveness.

Attitude to Health↗
PubMed1997

Evaluating models of working at the interface between mental health services and primary care.

BACKGROUND: This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services. METHOD: Methodological problems relevant to evaluation of innovative models of working at the interface are discussed. RESULTS: Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the 'shifted out-patient' model have eased this problem. By contrast the 'consultation-liaison' (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred. CONCLUSION: Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

Ambulatory Care↗
PubMed1995

Surviving the 'heartsink' experience.

The authors describe a pilot workshop designed to help doctors achieve a greater understanding of and ability to cope with their 'heartsink' patients. Participants were asked to list their personal objectives in attending and a number of cases were discussed in the group. A 'heartsink survival kit' was provided which consisted of skills and strategies which are useful in difficult consultations and an approach to reassessing the goals of the relationship which might promote a more realistic understanding. The workshop was videotaped and two scenarios are presented. The implications for further training are discussed.

Adaptation, Psychological↗
PubMed1995

Educational assessment of general practice experience for psychiatric trainees.

Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at a baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitation of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.

Education, Medical, Continuing↗
PubMed1992

The recognition and management of somatization. What is needed in primary care training.

This article addresses the medical education issues associated with teaching primary care residents about somatization. Specific training designed to recognize and manage somatization involves a hierarchical series of five knowledge domains with associated discrete skills. As a foundation, a biopsychosocial model must be embraced by the medical leadership of the training program. Second, because psychosocial stresses play a critical etiologic role in somatization, the ability to identify relevant psychosocial issues during medical interviewing is a fundamental skill. Third, basic psychiatric diagnostic areas (depression and anxiety) must be mastered as a prerequisite for identifying somatization. Specific interviewing and management techniques are reviewed, along with two current programmatic approaches. Finally, the concept of physician countertransference also must be explicitly addressed as part of the curriculum. Without assuring that these building blocks are in place, residents are likely to become overwhelmed by the management of somatizing patients and continue the pattern of frustration associated with these patients.

Curriculum↗
PubMed1992

Measuring psychiatric disorder in the recent past: the use of the Psychiatric Assessment Schedule retrospectively.

Ninety-four patients were asked about the presence of psychiatric symptoms on admission to hospital using the revised Psychiatric Assessment Schedule. Three months later they were asked to recall their symptoms at admission using the same instrument retrospectively. The results of the initial and retrospective interviews showed good rates of agreement in terms of PAS score, ID level, psychiatric 'caseness' and both CATEGO and DSM-III-R diagnoses. The study demonstrates that it is possible to make reliable measurements of the mental status of three months previously, simultaneously with assessments of current mental status. The uses of such a measuring instrument are discussed.

Follow-Up Studies↗
PubMed1992

Improving the skills of established general practitioners: the long-term benefits of group teaching.

This study set out to determine the long-term benefits of teaching psychiatric interview skills. Nine established general practitioners, eight of whom were also trainers, took part some 18 months after attending a problem-based interviewing course. Interview skills were assessed by rating behaviour during 10-minute videorecorded simulated consultations with role-players, recorded before and after training and at follow-up. The finding of an earlier study that, in terms of the course model, training successfully modified the doctor's behaviour, was largely replicated. In addition, not only were acquired skills maintained but further change took place during the follow-up period, change that can be seen as improvement in terms of the course model.

Clinical Competence↗
PubMed1992

Management of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners.

An improved teaching package is described which aims to help general practice trainees manage somatized presentations of psychological distress. The package comprises a training videotape in which a reattribution model is demonstrated, with material for role-play of new skills and small-group video feedback of consultations. Eighteen general practice trainees attending an 8-week course in psychiatry participated fully in the somatization management teaching programme. The teaching package was evaluated by blind rating of general interview skills and model specific skills demonstrated by trainees during 10 to 15-minute clinical interviews with professional role-players. Ratings were made on pre-training and post-training videotaped interviews. A significant improvement was demonstrated in general interview skills. Improvements were also noted in specific reattribution skills post-training. The evaluation revealed that skills in the model can be effectively learned, and that improvements in the package have resulted in its improved efficacy.

Clinical Competence↗