Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office.

Autor:	Haavet OR; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway o.r.haavet@medisin.uio.no., Šaltytė Benth J; Health Services Research Unit, Akershus University Hospital, Lorenskog, Norway.; Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway., Gjelstad S; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway., Hanssen-Bauer K; Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway., Dahli MP; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway., Kates N; Department of Psychiatry & Behavioural Neurosciences, Michael G. DeGroote School of Medicine McMaster University, Hamilton, Ontario, Canada., Ruud T; Division of Health Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2021 Dec 24; Vol. 11 (12), pp. e050036. Date of Electronic Publication: 2021 Dec 24.
DOI:	10.1136/bmjopen-2021-050036
Abstrakt:	Background: Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions. Aim: To investigate whether shared care with mental health professionals in GP offices increases the detection of youth's mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician. Design and Setting: This was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3-8 GP offices. One GP office was randomised to the intervention group and the other to the control group. Method: We used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth. Results: Over a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients' regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm. Conclusion: Shared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient's regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group. Trial Registration Number: NCT03624829; Results. Competing Interests: Competing interests: None (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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