General Practitioners' opinions on their practice in mental health and their collaboration with mental health professionals.

BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.

Regular visitors are not good substitutes for assessment of elderly patient satisfaction with nursing home care and services.

BACKGROUND: Due to physical and psychological impairments, elderly patients residing in homes are often unable to participate in studies on satisfaction with care services. While their regular visitors provide interesting information, patient-visitor response concordance requires study. Our objective was to measure patient-visitor agreement on quality of care and accommodation. METHODS: A survey was conducted on elderly people in 13 nursing homes and their visitors. The 125 patient-visitor pairs completed the same Nursing Home Satisfaction Questionnaire (NHSQ) independently, for which reliability and internal validity have previously been explored. Satisfaction scores for room comfort, meal provision, information, and medical/nursing care were calculated. To estimate patient-visitor concordance, intraclass coefficients, a bias index, and Pearson's correlation coefficients were calculated. RESULTS: Patient satisfaction scores ranged from 57.8 (information) to 78.6 (room comfort), and visitor satisfaction from 67.9 (meal provision) to 85.9 (medical/nursing care). Mean visitor scores were higher for all scales, with a small-to-moderate index bias statistically significant for medical/nursing care (p <.001), information (p <.001), and meal provision (p =.006). Intraclass correlation coefficients were low for room comfort, information, and medical/nursing care scales (0.08 to 0.18), and nearly acceptable for the meal provision scale (0.46). CONCLUSIONS: Visitors were not able to provide information on elderly patients' satisfaction with nursing home. Their assessments were milder than patient assessments. The NHSQ is reliable for use in either population, but patient and visitor assessments should not be merged in satisfaction studies.

Influence of the severity of stress urinary incontinence on quality of life, health care seeking, and treatment: A national cross-sectional survey.

OBJECTIVES: To determine the prevalence of stress urinary incontinence (SUI) symptoms in women and to evaluate the severity of these symptoms and resulting functional impairment with regard to urinary symptoms, quality of life (QoL) impairment, medical care seeking, and care facilities. METHODS: A national population based, cross-sectional study in France was conducted through an anonymous questionnaire that was completed by telephone. A randomized sample was extracted from the French telephone directory, December 2002 to March 2003. The main outcome measures were symptom severity, functional impairment, non SUI-related urinary symptoms, Contilife QoL scale, medical care seeking, and treatment. In total, 6,675 women aged 18-70 were selected and 5,160 questionnaires were completed and analyzed. RESULTS: The point-prevalence of SUI symptoms was 19.5% (1.1% for individuals with severe symptoms; 2.8% for those with severe functional impairment). Symptom severity and functional impairment were associated with older age, longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL (all p < 0.001). CONCLUSIONS: SUI symptoms are frequent in French women, causing embarrassment and negatively affecting their QoL. Though some could benefit from an effective therapy, only the most severely affected women who report SUI symptoms seek help and receive treatment.