COMMUNITY PSYCHIATRIC-NURSES IN PRIMARY HEALTH-CARE

Background. Community psychiatric nurses (CPNs) are increasingly worki ng in primary health care with non-psychotic patients. This study was designed to test the efficacy of this work. Method. The study was carr ied out in six health centres in north London with a fetal of 36 parti cipating general practitioners (GPs) and 11 CPNs. Using a randomised c ontrolled trial, 177 patients were referred by their GP and randomly a llocated to continuing GP care, immediate community psychiatric nursin g intervention, or placed on a 12-week waiting-list, after which time the patient was offered CPN intervention. A range of measures of sympt oms and social function were used, and ratings were carried out at ass essment and at 24 weeks. Results. Patients improved on all measures ov er time (P<0.001 for all measures). However, there was no difference b etween the group of patients receiving GP care and patients seen by th e CPN. Improvements seemed to be independent of the amount of contact. Drop-but rates from CPN intervention were high (50%). CPN drop-outs w ere more disabled to start with, but did as well as CPN treatment comp leters. Patients were more likely to drop out with trained than untrai ned CPNs. There was no evidence that referral to a CPN saved GP time. Conclusions. The results add weight to the argument that CPNs should r efocus their activity on people with serious mental health problems, a nd indicate that CPN education should focus on skill acquisition and i nterventions of proven effectiveness.