Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

Abstract Body

Background and purpose

Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Annual screening of their cardiovascular risk (CVR) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in cardiovascular risk management programmes in Dutch primary care is low.

The purpose was to explore the barriers and facilitators perceived by GPs to perform CVR screening in patients with SMI or receiving APs.

Methods

A qualitative interview study among Dutch GPs. Barriers and facilitators were explored by individual in-depth, semi-structured interviews using a computer-generated list of eligible patients with SMI or APs but without annual CVR screening. Data were analysed thematically.

Results

The main barriers were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through the use of a computer-generated list of eligible patients and (ii) involvement of family or carers.

Conclusions

This study indicates the preconditions required to facilitate GP inclusion of this specific population in primary care CVR management programmes, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence, and incentives for practices in deprived areas.

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Background: Increased physical activity (PA) results in huge benefits to mental and physical health. Despite this, many GPs struggle to support people to become regularly and consistently active. Encouraging PA is a simple, cost-effective way to reduce morbidity and mortality, reduce prescribing and improve mental health. Behavioural, social, policy and environmental approaches have been suggested to support people to become physically active. This workshop aims to help GPs support patients to become physically active to improve their mental health.

Learning objectives:

1. To better understand the relationship between PA and mental health.

2. To understand ways that General Practitioners can support patients to become physically active.

Methods: The virtual workshop will involve a mixture of whole group teaching, interactive questions, a quiz and breakout rooms to share experiences and learn from each other. Videos and example consultations will be used.

Proposed timetable:

Minutes 0-10:

Introduction

Aims

Minutes 10-20:

Global picture: the most/least active nations – interactive quiz.

WHO guidance: PA and mental health

Minutes 20-30*:

Shared experiences of recommending PA for mental health.

Minutes 30-45:

Review of current evidence about PA and mental health

Strength of the evidence base

Relationship to clinical practice

Minutes 45-60:

Ways to encourage PA:

Social/behavioural approaches

Policy and environmental approaches

Motivational interviewing

Minutes 60-70*:

Case scenarios

Minutes 70-85:

Motivational Interviewing to encourage PA:

Basic concepts

Example consultation

Resources

Minutes 85-90:

Summary

*=Breakout session

Conclusions: After attending, GPs will be more confident to recommend PA to improve mental health, understand the evidence supporting PA and mental health and understand ways to support patients to become physically active.

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1.Background and purpose: Health Systems’ Response Capacity (HSRC) is defined as the “ability of the health system to meet the population’s legitimate expectations regarding their interaction with the health system, apart from expectations for improvements in health or wealth”. HSRC is measured through eight domains which are dignity, confidentiality, communication, autonomy of individuals, prompt attention, basic quality of facilities, access to social support networks, and choice of care providers. The objective of this study is to deepen towards Primary Health Care Response Capacity by specifically using patients suffering from a mental disorder, and without these health problems.

2.Methods: Qualitative methodology. For this study, in-depth interviews were conducted with 28 patients with and without mental health disorders. An inductive thematic content analysis by pairs was performed using grounded theory in order to explore, develop and define the analysis.

3.Results: The fundamental domains for patients are dignity, communication, and rapid attention. People with mental health problems also highlight the domain of confidentiality as relevant, while patients who don't have a mental health problem prioritize the domain of autonomy. Patients with mental health disorders report a greater number of negative experiences in relation to the domain of dignity. The interrelationship between domains also appears in the discourses with there being mention of a relationship between clear communication, autonomy, dignity.

4.Conclusions: The prevalence of patients with mental illness who use primary care is quite high; therefore, it is necessary to determine the factors that influence its responsiveness, in order to plan the resources to be offered to this population at this early care level.

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1. Background and purpose: Uncontrolled, non-randomized studies have shown pre-and post-intervention improvements in patient-reported symptoms for bipolar disorder in association with supplementation with micronutrients and fish oil. This feasibility study aimed to guide a larger randomized, controlled trial in a rural primary care residency training clinic in the northeastern United States.

2. Methods: Patients were recruited with a confirmed diagnosis of bipolar disorder, either type. Baseline questionnaires were administered. Patients were randomized to active or placebo conditions in a 3:2 ratio. They were begun on 2 capsules twice daily of a micronutrient formula with 35 ingredients (details at www.truehope.com) (or a placebo containing riboflavin to turn their urine yellow) plus Wylie’s Alaskan Finest Fish Oil at a dose of 2.1 gm of eicosapentaenoic acid (EPA) acid daily (or olive oil placebo). The dose of micronutrients was increased monthly until a final dose of 8 capsules twice daily was achieved at the beginning of month 4. Questionnaires were administered monthly.

3. Results: One hundred twenty participants were randomized, and 50 continued for 4 months. Only 2 patients continued to 12 months. Of those who provided four months of data, statistically significant improvement occurred on the Clinical Global Impressions Scale (CGI) and the Basis-24 patient rating scale. On the My Medical Outcomes Profile version 2 (MYMOP2), treated patients reported greater improvement than untreated patients.

4. Conclusions: While patients improved when they took the supplements, patients were not able to continue to the one year mark. Future studies need patients’ physicians to be more directly involved in supporting compliance with the protocol.

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Introduction: Chronic obstructive pulmonary disease (COPD) is a major cause of worldwide morbidity and mortality, being associated with high prevalence of mental disorders. Therefore, we analysed men with self-reported COPD regarding socio-demographic data and several dimensions of mental health.

Methods: We analysed data from a population-based survey with a representative sample of Portuguese men aged ≥40 years (n=5,707), in 2014. We performed an age- and education-adjusted comparison of the prevalence of depression diagnosis, use of mental health consultations and different dimensions of mental health disease according to self-reported COPD diagnosis. We estimated weighted prevalences with 95% confidence intervals (95%CI) and adjusted prevalence ratios (PR) using Poisson regression. This study was approved by ethics committee.

Results: The nationwide prevalence of COPD in men was 6.4% (95%CI: 5.5-7.2), increasing with age, with a prevalence of 13.7% (95%CI: 10.8-16.6) for ≥75-year-old men. Men with COPD had an adjusted higher prevalence of depression diagnosis [PR=2.07 (1.45-2.98)]. They also reported more commonly life insatisfaction [PR=1.57 (1.23-2.00)], perceiving health-status as bad [PR=1.76 (1.44-2.16)], indifference for daily activities [PR=1.68 (1.39-2.03)], depressed mood [PR=1.67 (1.40-1.98)], sleep disturbances [PR=1.40 (1.20-1.62)], fatigue [PR=1.63 (1.44-1.84)], feeling of worthlessness or guilt [PR=2.13 (1.71-2.66)] and difficulty in concentrating [PR=1.62 (1.23-2.19)].

Conclusion: These findings provide evidence that COPD is associated with mental health, namely depression, being a major component of the burden of this disease among men. The clinicians should be aware of this association in order to have a high level of suspicion to mental health disturbances when assessing men with COPD.

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Experiences of GPS explaining central sensitization to patients with persistent physical symptoms

Objective

It is important for patients with persistent physical symptoms (PPS) to get an acceptable explanation for their symptoms. Central sensitization (CS) is an explanatory model for PPS and chronic pain in, amongst others, physiotherapy and rehabilitation medicine, but until now it is not often used by general practitioners (GPs). We aimed to assess the role of CS as explanatory model both on GPs and on patients.

Methods

We trained 33 GPs with their mental health nurse practitioners and (psychosomatic) physiotherapists. We gave a short training in explaining CS. We provided training materials like videos, drawings, an educational paper and books. After 0.5-1.5 year applying the model, 26 GPs participated in focus groups and interviews to report and discuss their experiences with and thoughts on CS as explanatory model. Next to that, we organized a multidisciplinary focus group with experts. Audio recordings were transcribed and thematically analysed.

Results

The model provided tools and insight for both GP and patient. GPs concluded that the CS explanation was acceptable for patients and helped them to get motivated for treatment. They indicated that they were struggling with the fear to miss somatic pathology. Sometimes they considered explaining the model rather challenging. Experts reported positive effects of the explanation on patients and rated the model high.

Conclusion

Though the model is complex and the issue of diagnostic uncertainty remains, it offers tools and insight for both patient and GP. Furthermore, it increases motivation for accepting treatment in patients, possibly leading to reduction of symptoms.