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New ICGP research examines out-of-hours mental health needs

The research report analysed consultations at a large out-of-hours primary care service in the South East (Caredoc) that had a primary or related mental health issue as a reason for attendance.

The research looked at whether these patients attended for advised follow-up care. The Caredoc service deals with over 280,000 episodes of care per annum and covers Carlow, Kilkenny, Waterford, Wexford, South Tipperary and South Wicklow with a population base of 550,000.

The research is the result of collaboration between the ICGP, Caredoc and the National Office for Suicide Prevention. It shows that, on average, over a third of those with a serious mental health need (suicide attempt/ideation, self- harm or erratic/irrational behaviour) identified as necessitating onward referral by out-of-hours doctors to their GP or hospital A&E do not attend.

The ICGP concludes that further study may be warranted to probe the causes for low compliance with referrals and whether this is due to the patients’ underlying medical condition, the appropriateness of the hospital setting for this care, or some other reason.

Commenting on the findings from the research, Dr Mark Murphy, Chair of Communications ICGP said: “A key issue highlighted in this report is that over one third of patients advised to attend either their GP or ED following their attendance with a mental health need at out-of-hours did not do so. The reason for this needs further investigation and the service provision for these patients needs to be examined.

“GPs are always notified of a patient attending out-of-hours. One of the conclusions which could be drawn from the study is the lack of dedicated integrated care facilities available to patients with a mental health need.”

Key findings from the study are:

· Over a one-year period, there were 3,844 out-of-hours presentations where the patient presented with a physical complaint that had a mental health component or with mental health issue, based on key word search.

· Among these consultations, depression was noted in 54.7 per cent of consultations, anxiety for 36.8 per cent, risk of or threatening suicide for 34.8 per cent and psychiatric condition in 31.7 per cent of consultations.

· Overall, 9.3 per cent were referred by the out-of-hours GP for follow-up to a hospital emergency department or were advised to attend their own GP.

· Those who attended out-of-hours with suicide attempt/ideation, self-harm or erratic/irrational behaviour were more likely than other groups to be referred for follow-up.

· During phase 2, over a six-month period, a total of 104 patients who were advised to attend their GP or ED following their consultation with the out-of-hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5 per cent did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7 per cent did not attend.

The ICGP annual conference is taking place this weekend in the Radisson Hotel, Galway. Over 250 general practitioners from across Ireland are attending the event.

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