How do general practitioners handle couple relationship problems in consultations? A focus group study.

BACKGROUND: Couple relationship problems are common and associated with health problems. The aim of this study was to explore general practitioners' (GPs') experiences, expectations, and educational needs when dealing with couple relationship problems in consultations. METHODS: We conducted an exploratory qualitative study by carrying out 3 semistructured focus group interviews with 18 GPs. We used systematic text condensation for the analyses. RESULTS: Participants shared their experiences of handling couple relationship problems in consultations. Three main themes emerged: (i) pragmatic case-finding: golden opportunities to reveal patients' couple relationship problems; (ii) conceptual and role confusion; (iii) professional competence and personal experience. While issues in relationships could serve as an explanation for relevant clinical problems, some GPs questioned whether relationship issues are strictly medical. All participants had engaged in individual supportive therapy, but none saw themselves as therapists. The interviews revealed that an individual supportive focus might lead to a consolidation of 1 partner's view, rather than challenging their position. Long-term doctor-patient relationships made it easier to talk about these issues. CONCLUSIONS: This study revealed several paradoxes. GPs are confident in offering individual supportive therapy for couple relationship issues but should be aware of substantial pitfalls such as side-taking and constraining change. Despite dealing with relationship problems, GPs do not see themselves as therapists. They use professional and personal experience but would benefit from increasing their skills in cognitive restructuring promoting behavioural flexibility facing relationship problems.

Couple relationship problems are common and often raised in general practitioner (GP) consultations as they are associated with health problems. We lack knowledge about what experiences, expectations, and educational needs GPs have when dealing with these problems. In 2020, we interviewed 18 GPs about how they handle couple relationship problems in their practice. Three main themes emerged: (i) Patients seldom present their relationship as the main problem. GPs conduct pragmatic case-finding to reveal relational problems that might be connected to, or be a risk factor for, health problems. (ii) GPs deal with couple relationship problems in several ways. Some think that they are not a medical problem, while others take a more holistic approach. In both cases, GPs lack the tools to assess couple relationship problems and to offer brief interventions. (iii) The most experienced doctors emphasized that their professional and personal experience qualified them to support their patients. Continuity in the doctor­patient relationship was also considered important. We revealed that taking a biopsychosocial approach can be challenged by searching for biomedical causes for problems. GPs should be aware of the pitfalls of individual supportive therapy in dealing with couple relationship issues, such as taking sides and impeding change.

How can we improve specialist health services for children with multi-referrals? Parent reported experience.

BACKGROUND: Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement. METHODS: As part of a larger, ongoing project; "Transitioning patients' Trajectories", we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6-12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression. RESULTS: Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1-5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time (r = .56, CI = .44-.69 / ß = 0.16, CI = .05-.28), accommodation of consultations (r = .71, CI = .62-.80 / ß = 0.25, CI = .06-.45 / ß = 0.27, CI = .09-.44), providing adequate information about the following treatment (r = .66, CI = .55-.77 / ß = 0.26, CI = .09-.43), and collaboration between different departments at the hospital (r = .68, CI = .57-.78 / ß = 0.20, CI = -.01-.40) were all statistically significantly associated with parents overall experience of care. CONCLUSIONS: The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services.