The impact of service wait times on General Practitioners' treatment of adolescent depression and anxiety

Bridianne O'Dea, Mirjana Subotic-Kerry, Thomas Borchard, Belinda Parker, Bojana Vilus, Frank Iorfino, Alexis E Whitton, Ben Harris-Roxas, Tracey D Wade, Madelaine K de Valle, Nicholas Glozier, Jennifer Nicholas, Michelle Torok, Taylor A Braund, Philip J Batterham
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Abstract

Background: General Practitioners (GPs) play a key role in the treatment of adolescent depression and anxiety, but their capacity to provide effective care may be compromised by long wait times. Aim: To examine the treatments and recommendations of GPs for adolescent patients with depression and/or anxiety in Australia, their referral practices to specialist care and estimated wait times for these, and the perceived impact of long wait times on GPs, their patients and their treatment. Design, Setting and Methods: An online survey of 192 GPs in Australia who treated adolescents (12 to 17 years old) with depression and/or anxiety. Results: GPs frequently referred adolescents with depression and/or anxiety to psychologists. The estimated wait time for psychologists (M: 57 days, SD: 47.9) was four times the proposed acceptable wait time (M: 16.7 days, SD: 27.0). The frequency of medication prescribing almost doubled during the wait time when compared to routine practice (14.6% versus 8.3%, respectively). Almost all GPs (81.8%) increased their level of care due to long wait times but had limited training in youth mental health and knowledge on appropriate strategies to do so effectively. Conclusion: The findings signify the discrepancies between the preferences of GPs for treatment availability in Australia and what they see as the experience for many adolescents with depression and/or anxiety who are referred to specialist care. Greater training, improved communication between referrer and referred services, and digital interventions may help GPs to reduce the negative impacts of long wait times on their adolescent patients.
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服务等待时间对全科医生治疗青少年抑郁和焦虑的影响
背景:目的:研究澳大利亚全科医生对患有抑郁症和/或焦虑症的青少年患者的治疗方法和建议、他们向专科医生转诊的做法和估计的等待时间,以及漫长的等待时间对全科医生、患者及其治疗的影响。设计、环境和方法:对澳大利亚192名治疗青少年(12至17岁)抑郁症和/或焦虑症的全科医生进行在线调查:结果:全科医生经常将患有抑郁症和/或焦虑症的青少年转介给心理医生。等待心理医生的估计时间(中位数:57 天,标数:47.9 天)是建议的可接受等待时间(中位数:16.7 天,标数:27.0 天)的四倍。与常规做法相比,在等待时间内开药的频率几乎增加了一倍(分别为 14.6% 和 8.3%)。几乎所有的全科医生(81.8%)都因等待时间过长而提高了护理水平,但他们在青少年心理健康方面接受的培训有限,也不了解如何有效地采取适当的策略。结论研究结果表明,在澳大利亚,全科医生对治疗可用性的偏好与他们眼中许多患有抑郁症和/或焦虑症的青少年被转介到专科治疗的经历之间存在差异。加强培训、改善转诊者与转诊服务机构之间的沟通以及数字化干预措施可帮助全科医生减少漫长的等待时间对青少年患者造成的负面影响。
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