A patient-centred referral pathway for mild to moderate lifestyle and mental health problems: Does this model work in practice?

Abstract

BACKGROUND AND CONTEXT: The Primary Lifestyle Options Programme was an innovative eight-month, patient-centred, early primary care–based pilot aimed at identifying and promptly enabling people with mild to moderate mental health and lifestyle problems to access a range of free interventions as soon as possible. PROBLEMS: Mild to moderate mental health and lifestyle issues are easily overlooked in primary care. Patients with these problems, once identified, often need support to choose and access treatment providers. STRATEGIES FOR IMPROVEMENT: During a GP visit a patient requests help by completing a CHAT (Case-finding and Help Assessment Tool) which assesses depression, anxiety, abuse, anger, exercise level, insomnia, and addictions (gambling, tobacco, alcohol and other substances). Patients subsequently have a 30-minute GP consultation where a range of services to address identified problem(s) is offered; this choice is assisted by a comprehensive resource manual. A programme coordinator facilitates access to services by making appointments and liaising between patients and providers. A follow-up GP consult is available. RESULTS: 456 patients (6% Maori) aged from 15 to 84 years requested help via the CHAT for one to seven issues per patient, over an eight-month period. Anxiety, depression and insomnia were the commonest reasons for requesting help. A feedback questionnaire focussed on the usefulness and practicality of the pathway, showing widespread approval from patients, GPs and other treatment providers. CONCLUSIONS: This programme enables a patient to identify and request help for mental health and lifestyle problems at a mild–moderate stage, and to be supported through an intervention pathway that otherwise is unlikely to be available in a busy primary care environment. KEYWORDS: Primary care, patient-centred, mental health