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Abstract Background The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. Methods focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding. Results The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made Conclusion Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice.

Purpose To evaluate the added value of somatic screening for patients with severe mental illness over regular care. Design and Methods We compared the information on somatic health problems collected by screening with the general practitioner ( GP) files ( n = 118). Findings The mean number of somatic health problems detected with somatic health screening was significantly higher than those noted in GP records ( p < .01). Practice Implications Somatic health screening is an addition to the care provided by the GP. Advanced mental health nurses can play a key role in somatic health screening and initiating further cooperation and communication of GP and mental health care. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization (WHO) definition, palliative care should be initiated in an early phase and not be restricted to terminal care. In the literature, no validated tools predicting the optimal timing for initiating palliative care have been determined.Aim: The aim of this study was to systematically develop a tool for GPs with which they can identify patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and cancer respectively, who could benefit from proactive palliative care.Design: A three-step procedure, including a literature review, focus group interviews with input from the multidisciplinary field of palliative healthcare professionals, and a modified Rand Delphi process with GPs.Method: The three-step procedure was used to develop sets of indicators for the early identification of CHF, COPD, and cancer patients who could benefit from palliative care.Results: Three comprehensive sets of indicators were developed to support GPs in identifying patients with CHF, COPD, and cancer in need of palliative care. For CHF, seven indicators were found: for example, frequent hospital admissions. For COPD, six indicators were found: such as, Karnofsky score ≤50%. For cancer, eight indicators were found: for example, worse prognosis of the primary tumour.Conclusion: The RADboud indicators for PAlliative Care Needs (RADPAC) is the first tool developed from a combination of scientific evidence and practice experience that can help GPs in the identification of patients with CHF, COPD, or cancer, in need of palliative care. Applying the RADPAC facilitates the start of proactive palliative care and aims to improve the quality of palliative care in general practice. [ABSTRACT FROM AUTHOR]

The article examines the way family physicians address the diagnosis and management of depression in palliative care patients in the Netherlands. It notes their perception that the diagnosis and management of the condition in those patients is challenging. It mentions their reliance on their clinical judgment and strongly considered context and background factors of the patients. It also emphasizes their suggestions to improve the management of depression in palliative care patients.

Background: Although it is now common to see spirituality as an integral part of health care, little is known about how to deal with this topic in daily practice.Aim: To investigate the literature about GPs' views on their role in spiritual care, and about their perceived barriers and facilitating factors in assessing spiritual needs.Design: Qualitative evidence synthesis.Method: The primary data sources searched were MEDLINE, Web of Science, CINAHL, Embase, and ATLA Religion Database. Qualitative studies that described the views of GPs on their role in providing spiritual care, or that described the barriers and facilitating factors they experience in doing so, were included. Quantitative studies, descriptive papers, editorials, and opinion papers were excluded.Results: Most GPs see it as their role to identify and assess patients' spiritual needs, despite perceived barriers such as lack of time and specific training. However, they struggle with spiritual language and experience feelings of discomfort and fear that patients will refuse to engage in the discussion. Communicating willingness to engage in spiritual care, using a non-judgemental approach, facilitates spiritual conversations.Conclusion: The results of the studies included here were mostly congruent, affirming that many GPs see themselves as supporters of patients' spiritual wellbeing, but lack specific knowledge, skills, and attitudes to perform a spiritual assessment and to provide spiritual care. Spirituality may be of special consequence at the end of life, with an increased search for meaning. Actively addressing spiritual issues fits into the biopsychosocial-spiritual model of care. Further research is needed to clarify the role of the GP as a spiritual care giver. [ABSTRACT FROM AUTHOR]

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Background Anxiety disorders are common in general practice and are associated with several problems regarding recognition and management Aim To systematically evaluate the effectiveness of interventions aimed at improving recognition, diagnosis, and management of patients with anxiety disorders. Design of study Systematic review. Method MEDLINE, EMBASE, PsychINFO, and the Cochrane Clinical Trials' Register were searched up until 2003. Randomised controlled trials, controlled before/after trials, and interrupted time series for professional, organisational, financial, and regulatory interventions were eligible. Primary effect measures consisted of anxiety outcomes, diagnosis, prescription, and referral. Two reviewers independently made eligibility judgments: eight out of 563 articles were found to be eligible. Two reviewers participated independently in the quality assessment and data extraction process using a standardised form based on the Effective Practice and Organisation of Care checklist. Relative risks or standardised mean differences were calculated when possible. Results Four professional interventions and three organisational interventions were examined. In general, the professional interventions seemed to increase recognition, referral, and prescription as well as improving anxiety outcomes. Two out of three organisational interventions showed a positive effect on anxiety outcomes. The one study that took prescription into account showed no effect. Conclusions The quality of care for patients with anxiety can be improved. A combination of professional and organisational interventions in which an external expert is introduced seems to be most promising. Additional research is nevertheless necessary to determine the exact effects of such interventions using patient effect measures, economic evaluations, and feasibility studies. [ABSTRACT FROM AUTHOR]

Background: The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders., Methods: focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding., Results: The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made, Conclusion: Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice.

Background: Somatic comorbidity in patients with depression and anxiety is very prevalent and mainly studied with respect to chronic conditions. Patients with mental health problems are high utilizers of medical care. This may be a result of their functional impairment and illness behaviour, but also of their interpretation of common symptoms and their attitude towards healthcare. Therefore, we expect that patients with mental health problems are more likely to present with minor illnesses to the general practitioner., Objective: To assess the association of minor illnesses with depression and anxiety., Methods: A historic cohort study in a general practice database of 13,500 patients, with more than 30 years' follow-up. Three prevalent categories of minor illnesses were assessed: skin, musculoskeletal, and respiratory disorders. We studied the number of patients with a diagnosis of a minor illness in patients with depression and anxiety disorder compared with their matched controls., Results: We found 799 patients with depression and 153 patients with anxiety disorder. More patients with depression present skin, musculoskeletal, and respiratory disorders in the year before and the years following the initial diagnosis of depression. Depression appeared to be statistically significantly associated with presenting all three types of minor illnesses. More patients with anxiety disorder present skin and respiratory disorders in the year before diagnosis, and more musculoskeletal disorders in the years following the diagnosis of anxiety disorder. Anxiety disorder appeared to be statistically significantly associated with presenting skin and musculoskeletal morbidity., Conclusion: Compared to controls, more patients with depression and anxiety disorder present minor illnesses. This could be due to their high attendance rate, altered illness behaviour, or to factors--e.g., stress--underlying both the development of depression or anxiety and the susceptibility to diseases.