The impact of training in problem-based interviewing on the detection and management of psychological problems presenting in primary care

Background. The vast majority of mental health problems present to primary care teams. However, rates of underdiagnosis remain worryingly high. This s tudy explores a GP-centred approach To these issues. Aim. To examine the impact of training in problem-based interviewing (BPI) on the detection and management of psychological problems in primary care. Method. The detection and management of psychological problems by 10 genera l practitioners (GPs) who had received PBI training 12 months earlier was c ompared with that of 10 control GPs matched for age, sex, clinical experien ce, and practice setting; and had originally applied for, but had not been able 50 attend, BPI training. Consecutive attendees at one randomly selecte d surgery undertaken by each GP were invited to participate in the study. T wo hundred and eighty patients living in Newcastle upon Tyne met inclusion criteria and gave informed consent. The presence or absence of psychologica l problems was assessed using patient self-ratings on the 28-item version o f the General Health Questionnaire (GHQ) and blind independent observer rat ings of the brief Present State Examination (PSE). Patient satisfaction wit h interviews was rated using the Medical interview Satisfaction Scale (MISS ). After each consultation, the GPs (blind to subjective and observer ratin gs) recorded their assessment and management of the patients' problems on a Practice Activity Card (PAC). Results. In comparison with control GPs, index GPs demonstrated significant ly greater sensitivity in the detection of psychological problems in the GH Q-PAC ratings. The absolute decrease in misdiagnosis of GHQ cases was 9% an d of PSE cases was 15%. Patients meeting GHQ criteria for caseness were mor e likely to be prescribed psychotropic medication by an index GP than compa red with a control GP. Length of interview did not differ between the group s and mean scores on the MISS suggested that patients attending PBI-trained GPs, compared with control GPs, were as satisfied or slightly more satisfi ed with their consultation. Conclusion. In comparison with control GPs, PBI-trained GPs were better at recognizing and managing psychological disorders. The potential benefits of BPI training are dis cussed in light of other attempts to improve mental h ealth skills in primary care.