ABSTRACT
OBJECTIVE: To describe the development and functioning of the HIV and hepatitis C mental health in primary care service (H2M), a multidisciplinary team that works with local general practitioners (GPs) and the St Vincent's Hospital immunology clinic to meet the mental health needs of their patients living with HIV/AIDS and those undergoing interferon-based treatment for hepatitis C. METHOD: The authors describe and review the service, using information from a database of patient characteristics and from a GP satisfaction survey. RESULTS: GP satisfaction with the service was high and participating GPs have increased their knowledge and understanding of their patients' mental health problems. CONCLUSIONS: Over eight years, H2M has become a well utilized and valued specialty team with over 1,200 referrals in that time. Patients with other chronic health conditions, such as diabetes, cardiac and renal disease, could benefit from a similar service model.
Subject(s)
General Practice/methods , HIV Infections/psychology , Hepatitis C/psychology , Mental Health Services/organization & administration , Patient Care Team/organization & administration , Primary Health Care/methods , Program Development , Adult , Attitude of Health Personnel , Female , HIV Infections/complications , Hepatitis C/complications , Hepatitis C/drug therapy , Humans , Interferons/therapeutic use , Male , Outcome and Process Assessment, Health Care , PrognosisABSTRACT
OBJECTIVES: The aim of this study was to present an overview of the Green Card Clinic, a novel brief intervention service for patients presenting to the emergency department following deliberate self-harm (DSH) or with suicidal ideation, to examine its effectiveness in terms of service utilization, and patient and clinician feedback, and to explore the correlates of repeated DSH. METHOD: The aims and structure of the Green Card Clinic are described. We highlight our patient-centred approach involving self-identification of difficulties from a list of problem areas, coupled with tailored intervention strategies. Relevant data are presented and characteristics of repeat DSH patients are compared to the first-episode group. RESULTS: Between 1998 and 2005, 456 DSH patients were referred to the clinic. Of these, 75% (n = 344) attended the first session, 43% (n = 197) the second session, 26% (n = 117) the third session, and 16% (n = 73) completed a 3-15 month follow-up. Clinic attenders (mean age 31.6 years, 57% female) reported a diverse range of self-identified problems and repeat DSH patients reported worse depression, poorer health-related behaviours, and a greater number of problems than those presenting after first-episode DSH. CONCLUSIONS: The clinic achieved high rates of first session attendance. This may have been attributable to the use of a few specific strategies aimed at increasing compliance, such as the green card, next-day appointments and assertive follow-up of non-attenders. For repeat self-harmers, we advocate an approach aimed at 'lifestyle change' rather than based on current psychological stressors. The Green Card Clinic service, involving a range of interventions tailored to meet the multitude of presenting needs, appears to be an acceptable and flexible approach to brief intervention for DSH.
Subject(s)
Ambulatory Care Facilities , Mental Health Services/organization & administration , Patient-Centered Care/methods , Psychotherapy, Brief/methods , Referral and Consultation/statistics & numerical data , Self-Injurious Behavior/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Australia , Feedback , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Compliance/statistics & numerical dataABSTRACT
OBJECTIVE: To determine whether psychological morbidity is associated with poor compliance with antiretroviral medication in HIV-positive subjects. METHOD: This is a cross-sectional survey of patients attending a public HIV clinic in Sydney. Volunteers completed a survey which gathered data on substance use, psychological distress, attitudes to illness and medication, and self-reported medication adherence. Psychological morbidity was assessed using the 28 question General Health Questionnaire, GHQ-28, and adherence was assessed using a combination of direct self-report and indirect questions. RESULTS: Forty-four per cent of subjects were identified as suffering psychological disorder on the GHQ. They reported significantly poorer adherence to antiretroviral medication than subjects not identified as 'cases' (odds ratio 4.5). Expressed scepticism about medication and previous use of psychotropics was also associated with poor adherence. CONCLUSIONS: Psychological morbidity is associated with poor adherence to antiretroviral medication. It is not known whether treatment of identified psychological morbidity leads to improved antiretroviral medication adherence and better medical outcome. A longitudinal study could help answer this question.