An Evaluation of Cooperation: Physicians and Psychiatrists

1. An Evaluation of Cooperation: Physicians and Psychiatrists Irène Bohn, Jean Pierre Aubert, Laurence Coblentz,Tim Greacen, Michèle Guegan,Michel Guillard,Michel Lejoyeux,Michel Nougairède, Gail Rosecrance I.BOHN WONCA EUROPE 2007

2. The Health of the Mentally Sick • High Early Mortality and Disease Incidence • Linked to • numerous risk factors • Medication’s toxicity • Inadequate cooperation among health care professionals? • A French Study : 1/3 of general practioners following schizophrenics have regular contact with the services dispensing psychiatric care. I.BOHN WONCA EUROPE 2007

3. Objectives • Determine the proportion of psychiatric patients in out-patient treatment who have a personal physician • Measure the amount of information personal physicians have on their patient’s psychiatric pathology and treatment • Measure the amount of information psychiatrists have on their patient’s physical ailments and treatments • Evaluate the number of doubled-up prescriptions for psychotropic drugs and the drugs’ interactions I.BOHN WONCA EUROPE 2007

4. Method • Single-site Study (CMP - Community Mental Health Service – Paris, 18è) • Length: 1 month (March 2006) • Patients:all patients consulting a psychiatrist during the month • Arbitrary Definition : a doctor is considered as patient’s personal physician when he had seen a patient more than once in the previous year I.BOHN WONCA EUROPE 2007

5. In Three Stages • Psychiatrists complete Questionnaire with patient - Looking for the existence of a personal physician - Identifying psychiatric pathologies, treatments for psychiatric pathologies • Contact made with Physicians - Is he really the designated personal physician? • What physical ailments are under treatment? • Awareness of psychiatric pathology and treament? - Prescriptions for psychotropic medication? • Investigation of Mental Health Service patient files • Mention of personal physician? - Mention of physical ailment and treatment? I.BOHN WONCA EUROPE 2007

6. Results : 143 patients included I.BOHN WONCA EUROPE 2007

7. 65% of patients identify a personal physician • However, only 33% (41) really have a personal physician • Chronic physical ailments: 35 patients • Long-term treatment: 30 patients I.BOHN WONCA EUROPE 2007

8. Awareness of Psychiatric Pathology • 91% of personal physicians knew patient was also treated in a mental health facility • Ignorance of psychiatric pathology in 56% of cases • Ignorance of psychiatric treatment in 71% of cases • Personal physicians gave 35% of patients psychotropic medication I.BOHN WONCA EUROPE 2007

9. Investigation of Community Mental Health Service Patient files Name of Personal Physician: 27% Mention of Physical Ailment: 39% Mention of Complete Treament for Physical Ailments : 36% I.BOHN WONCA EUROPE 2007

10. 31 interactions or relative contra indications I.BOHN WONCA EUROPE 2007

11. Alarming Results Require Urgent Action • Limited medical care for physical ailments and lack of communication between psychiatrists and personal physicians • Systems to improve access to care and the communication among professionals. • Increase study of cooperation among these professionals I.BOHN WONCA EUROPE 2007