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Treatment of common mental disorders in Australian general practice
Author(s) -
Hickie Ian B,
Davenport Tracey A,
Naismith Sharon L,
Scott Elizabeth M,
HadziPavlovic Dusan,
Koschera Annette
Publication year - 2001
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2001.tb143786.x
Subject(s) - medicine , audit , intervention (counseling) , psychological intervention , mental health , general practice , family medicine , psychiatry , management , economics
Objective : To determine the rates and predictors of treatments for patients with common mental disorders in Australian general practice. Design and setting : Cross‐sectional national audit of general practices throughout Australia in 1998–1999. Participants : 46515 ambulatory care patients attending 386 GPs. Screening tools : Prevalence of common mental disorders — 12 items from the 34‐item SPHERE self‐report questionnaire and associated classification system; pharmacological and non‐pharmacological treatment provided, as reported by the GPs — questions relating to treatments provided; predictors of treatments — self‐report questions about demography for patients and GPs, and about practice organisation for GPs. Main outcome measures : GPs' reported provision of pharmacological and non‐pharmacological treatments; and patient, GP and practice characteristics predicting treatment provision. Results : There were complete data on treatment for 39 983 patients. 27% (10 752) of all patients received some form of intervention; 21% (8304) received non‐pharmacological and 12% (4765) received pharmacological treatments. Non‐pharmacological treatments were mostly non‐specific counselling and support (83%; 6892/8304). Among the 10 303 patients with the most severe level of psychological disorders, only 50% (5152) received any intervention (38% [3872] received non‐pharmacological and 27% [2766] pharmacological treatments). Evidence‐based treatments were provided to only 12% (4961) of all patients (and only 27% [2802] of the 10 303 with the most severe disorders). Although the newer antidepressant agents were commonly prescribed, older medications (mainly tricyclic antidepressants) were prescribed to older (OR, 1.29; 95% CI, 1.07–1.56), less educated (OR, 1.41; 95% CI, 1.12–1.79) and female (OR, 1.44; 95% CI, 1.23–1.70) patients. Among the 8304 patients receiving non‐pharmacological treatments, specific (evidence‐based) treatments were provided to only 17% (1412); these patients were typically middle‐aged (OR, 2.94; 95% CI, 2.32–3.73) and the providing GPs were typically not in full‐time practice (OR, 3.34; 95% CI, 2.56–4.17). Conclusion : Practitioners largely provide non‐specific, non‐pharmacological interventions for patients with common mental disorders. Even among those with the most severe disorders, only a minority receive pharmacological or specific evidence‐based non‐pharmacological treatments.