Mental healthcare and pragmatic shared decision-making in general practice: An interview study.

IF 2.5 Q2 PRIMARY HEALTH CARE BJGP Open Pub Date : 2024-11-05 DOI:10.3399/BJGPO.2024.0111
Désanne Noordam, Monique Heijmans, Janneke Noordman, Tim Olde Hartman T, Sandra van Dulmen
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Abstract

Background: Healthcare providers in general practice are expected to deliver mental healthcare to patients through shared decision-making (SDM). It is unclear if they perceive their SDM to be affected by challenging circumstances in mental healthcare, eg, how waiting time for therapy plays a role.

Aim: To explore how healthcare providers and patients in general practice engage in SDM, given the challenging circumstances in mental healthcare.

Design & setting: A qualitative interview study in seven Dutch general practices.

Method: Semi-structured interviews were conducted with general practitioners (GPs; N=9), practice nurses mental health (PNMHs; N=8) and patients that sought mental healthcare (N=18). The interviews were deductively and inductively thematically analyzed.

Results: The participants mainly reported on SDM regarding treatment in secondary mental healthcare. The PNMHs explained they lack an overview of available treatments and waiting times in facilities. The PNMHs therefore instruct patient to also search for options themselves. Most patients found this approach burdensome, especially those new to mental healthcare. These patients were said to often express no strong treatment preferences and rely on advice by their healthcare providers. The GPs and PNMHs explained that in such cases, they often adopt a pragmatic approach and for example refer indecisive patients to facilities with little waiting time.

Conclusion: The healthcare providers and patients in general practice experience they adapt their approach to SDM in reaction to the circumstances in mental healthcare. Further exploration of how SDM is implemented and shaped by challenging circumstances across different healthcare settings is needed.

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全科实践中的心理保健和务实的共同决策:访谈研究。
背景:全科医疗服务提供者应通过共同决策(SDM)为患者提供心理保健服务。目前尚不清楚他们的 SDM 是否会受到精神医疗挑战环境的影响,例如,等待治疗的时间是如何发挥作用的。目的:探讨在精神医疗挑战环境下,全科医疗机构的医疗服务提供者和患者如何参与 SDM:在荷兰的七家全科诊所进行定性访谈研究:对全科医生(GPs;N=9)、心理健康执业护士(PNMHs;N=8)和寻求心理保健的患者(N=18)进行了半结构化访谈。对访谈进行了演绎和归纳主题分析:结果:参与者主要报告了在二级精神医疗保健中有关治疗的 SDM 情况。PNMHs 解释说,他们缺乏对设施中可用治疗和等待时间的总体了解。因此,PNMHs 会指导患者自己寻找治疗方案。大多数病人认为这种做法很麻烦,尤其是那些刚刚接触精神医疗的病人。据说,这些病人往往对治疗没有强烈的偏好,而是依赖于医疗服务提供者的建议。全科医生和 PNMHs 解释说,在这种情况下,他们通常会采取务实的方法,例如将犹豫不决的病人转介到等候时间较短的机构:结论:全科医疗机构的医疗服务提供者和患者会根据精神医疗的具体情况调整他们的 SDM 方法。我们需要进一步探索在不同的医疗环境中,如何实施 SDM,以及如何在具有挑战性的环境中塑造 SDM。
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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
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