RANDOMIZED CONTROLLED TRIAL OF TEACHING GENERAL-PRACTITIONERS TO CARRY OUT STRUCTURED ASSESSMENTS OF THEIR LONG-TERM MENTALLY-ILL PATIENTS

Objective-To assess the impact of teaching general practitioners to ca rry out structured assessments of their long term mentally ill patient s. Design-Randomised controlled trial. Setting-Sixteen group general p ractices in South Thames (west) region. Subjects-44O adults disabled b y long term mental illness. Interventions-Patients were identified by using practice data with help from local psychiatric and social servic es. In eight practices the practitioners were taught a structured asse ssment schedule to use with patients every six months for two years. M ain outcome measures-Changes in drug treatments, referrals, consultati on rates, and recording of preventive health data in the two years aft er intervention. Results-Follow up data were available on 373 patients (84 . 7%). At least one structured assessment was recorded for 127 pa tients in the intervention group but only 29 had four assessments reco rded. Participating practitioners considered the structured assessment to be time consuming and reported that it did not often lead directly to changes in treatment or referrals. Changes in treatment with neuro leptic drugs and referrals to community psychiatric nurses, however, w ere significantly more frequent in the intervention group (differences for intervention group minus control group adjusted for activity in t wo years before intervention were 14 . 3% (95% confidence interval 4 . 3% to 24 . 33%; P < 0 . 01) for neuroleptic drugs and 13 . 3% (2 . 0% to 24 . 6%; P < 0 . 05) for referrals). There were no significant dif ferences in psychiatric admissions, use of the Mental Health Act, drug overdoses, prescriptions, referrals or admissions for physical proble ms, consultation rates, continuity of care, or recording of preventive data. Conclusions-Teaching general practitioners about the problems o f long term mentally ill patients may increase their involvement in pa tients' psychiatric care. Regular structured assessments do not seem f easible in routine surgery appointments. More training for general pra ctitioners and increased resources such as more nurse time may be nece ssary if improvements in care of long term mentally ill patients in ge neral practice are to be generalised.