Abstract
Psychological problems constitute 24% of all cases seen in primary health care (PHC) settings, but only 5.3% of patients present them as the main reason for their visits. These findings imply that there is underdiagnosis of psychiatric disorders in PHC. This study was aimed at assessing the outcome of a 2 week course in psychiatry for a group of PHC physicians 1 month and 2 years later. It was a prospective pre-post intervention study. Fourteen PHC physicians were exposed to a 2 week course in psychiatry. A pre-intervention World Health Organisation questionnaire was administered just before the course and a post-intervention one was completed 1 month and 2 years after the course. A scoring system for three vignette cases (depression, alcohol dependency and anxiety with panic attacks) was created and validated by two consultants in order to measure the diagnosis and management skills of the PHC physicians before and after the course. Fifty-seven percent of the sample were not exposed to any postgraduate course in psychiatry and the same percentage had no interest. After the course, the self-report of the PHC physicians differed significantly. The referral rate (P = 0.02), the prescription rate of psychotropic drugs (0.028 for sedatives and 0.05 for tricyclics) and the number of counselling sessions (P 0.05) increased significantly for patients with mental disorders. These results were supported by figures from a Ministry of Health Statistical Report for two PHC centres (where the participating physicians were working). These figures showed an increase in the number of psychiatric diagnoses (from 205 patients in 1996 to 436 in 1997), an increase in the number of psychiatric referrals (from 37 patients in 1996 to 76 in 1997) and an increase in the number of psychotropic medications prescribed (from 390 tablets in 1996 to 1308 in 1997) (chi (2) = 22.77 and P = 0.00001). The scores for diagnostic skills improved dramatically (P = 0.002 for depression, 0.03 for anxiety and 0.05 for alcohol dependence). For management, only depressive disorders showed a significant change in score (P = 0.009) while skill in managing anxiety (P = 0.01) and alcohol dependence (P = 0.09) did not improve significantly after the course. A 2 week training course in psychiatry for PHC physicians is effective in improving their diagnostic skills. Management skills, particularly in the areas of anxiety and alcohol dependency, may need a more prolonged and/or different clinical training setting. Primary Care Psychiatry. 2000: 6:77-81. Copyright (C) 2000 by LibraPharm Limited.