Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

GP perspectives on a psychiatry phone line in Western Australia’s Great Southern region: implications for addressing rural GP workload

Beatriz Cuesta-Briand https://orcid.org/0000-0002-5858-5713 A * , Daniel Rock B C D , Layale Tayba E , James Hoimes F , Hanh Ngo A , Michael Taran E and Mathew Coleman A E F G
+ Author Affiliations
- Author Affiliations

A Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia.

B WA Primary Health Alliance, Subiaco, WA 6008, Australia.

C Discipline of Psychiatry, UWA Medical School, The University of Western Australia, Crawley, WA 6009, Australia.

D Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia.

E Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia.

F Midwest Mental Health Service, WA Country Health Service, Geraldton, WA 6530, Australia.

G Telethon Kids Institute, Nedlands, WA 6009, Australia.


Australian Journal of Primary Health 30, PY23039 https://doi.org/10.1071/PY23039
Submitted: 28 February 2023  Accepted: 1 September 2023  Published: 25 September 2023

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia’s Great Southern region in 2021 to describe GPs’ perspectives on the service and reflect on how it may help alleviate rural GP workload.

Methods

The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation.

Results

A total of 45 GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs’ confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance.

Conclusions

Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings.

Keywords: evaluation, GP workload, patient complexity, primary care, psychiatry advice service, psychiatry phone line, rural adversity, rural mental health.

References

AIHW (2022) Mental health services in Australia: mental health impact of COVID-19. Australian Institute of Health and Welfare.

Aknin LB, De Neve J-E, Dunn EW, Fancourt DE, Goldberg E, Helliwell JF, Jones SP, Karam E, Layard R, Lyubomirsky S, Rzepa A, Saxena S, Thornton EM, VanderWeele TJ, Whillans AV, Zaki J, Karadag O, Ben Amor Y (2022) Mental health during the first year of the COVID-19 pandemic: a review and recommendations for moving forward. Perspectives on Psychological Science 17, 915-936.
| Crossref | Google Scholar |

Australian Bureau of Statistics (2022) Health conditions prevalence. Available at https://www.abs.gov.au/statistics/health/health-conditions-and-risks/health-conditions-prevalence/2020-21 [Accessed 5 October 2022]

Australian Institute of Health and Welfare (2023) Mental health workforce. Available at https://www.aihw.gov.au/mental-health/topic-areas/workforce [Accessed 16 June 2023]

Bradstock SE, Wilson AJ, Cullen MJ, Barwell KL (2005) Telephone-based psychiatry advice service for general practitioners. Medical Journal of Australia 183, 90.
| Crossref | Google Scholar | PubMed |

Braillard O, Slama-Chaudhry A, Joly C, Perone N, Beran D (2018) The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC Family Practice 19, 159.
| Crossref | Google Scholar |

Britt H, Miller GC, Bayram C, Henderson J, Valenti L, Harrison C, Pan Y, Charles J, Pollack AJ, Chambers T, Gordon J, Wong C (2016) ‘A decade of Australian general practice activity 2006-07 to 2015-16. General Practice Series No. 41.’ (Sydney University Press: Sydney)

Clough BA, Ireland MJ, Leane S, March S (2020) Stressors and protective factors among regional and metropolitan Australian medical doctors: a mixed methods investigation. Journal of Clinical Psychology 76, 1362-1389.
| Crossref | Google Scholar | PubMed |

Coleman M, Cuesta-Briand B, Collins N (2022) Rethinking accessibility in light of the Orange Declaration: applying a socio-ecological lens to rural mental health commissioning. Frontiers in Psychiatry 13, 930188.
| Crossref | Google Scholar |

DHWA (2021) Western Australian Burden of Disease Study 2015 – summary report for Health Regions: 2021. Department of Health Western Australia, Perth.

Fredheim T, Danbolt LJ, Haavet OR, Kjønsberg K, Lien L (2011) Collaboration between general practitioners and mental health care professionals: a qualitative study. International Journal of Mental Health Systems 5, 13.
| Crossref | Google Scholar |

Green J, Willis K, Hughes E, Small R, Welch N, Gibbs L, Daly J (2007) Generating best evidence from qualitative research: the role of data analysis. Australian and New Zealand Journal of Public Health 31, 545-550.
| Crossref | Google Scholar | PubMed |

Harrison C, Henderson J, Miller G, Britt H (2016) The prevalence of complex multimorbidity in Australia. Australian and New Zealand Journal of Public Health 40, 239-244.
| Crossref | Google Scholar |

Hoffman R, Mullan J, Bonney A (2023) “A cross-sectional study of burnout among Australian general practice registrars”. BMC Medical Education 23, 47.
| Crossref | Google Scholar |

Innes AD, Campion PD, Griffiths FE (2005) Complex consultations and the ‘edge of chaos’. British Journal of General Practice 55, 47-52.
| Google Scholar |

Koné Pefoyo AJ, Bronskill SE, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, Maxwell CJ, Bai YQ, Wodchis WP (2015) The increasing burden and complexity of multimorbidity. BMC Public Health 15, 415.
| Crossref | Google Scholar | PubMed |

McCallum M, MacDonald S (2021) Exploring GP work in areas of high socioeconomic deprivation: a secondary analysis. BJGP Open 5, BJGPO.2021.0117.
| Crossref | Google Scholar |

Patrick R, Snell T, Gunasiri H, Garad R, Meadows G, Enticott J (2023) Prevalence and determinants of mental health related to climate change in Australia. Australian & New Zealand Journal of Psychiatry 57, 710-724.
| Crossref | Google Scholar |

Perkins D, Farmer J, Salvador-Carulla L, Dalton H, Luscombe G (2019) The Orange Declaration on rural and remote mental health. Australian Journal of Rural Health 27, 374-379.
| Crossref | Google Scholar | PubMed |

Productivity Commission (2021) Mental health – productivity commission inquiry. Report no. 95. Australian Government, Canberra.

QSR International (2021) NVivo. Available at https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home [Accessed 8 March 2021]

RACGP (2022) General practice: health of the nation 2022. Royal Australian College of General Practitioners.

Rural Health West (2023) Rural general practice in Western Australia: annual workforce update. November 2022. Rural Health West, Perth.

Sankaranarayanan A, Allanson K, Arya DK (2010) What do general practitioners consider support? Findings from a local pilot initiative. Australian Journal of Primary Health 16, 87-92.
| Crossref | Google Scholar | PubMed |

Tian PGJ, Harris JR, Seikaly H, Chambers T, Alvarado S, Eurich D (2021) Characteristics and outcomes of physician-to-physician telephone consultation programs: environmental scan. JMIR Formative Research 5, e17672.
| Crossref | Google Scholar |

WA Country Health Service (2021) Great Southern. Available at https://www.wacountry.health.wa.gov.au/Our-services/Great-Southern [Accessed 5 October 2022]

Western Australian General Practice Education and Training (2022) WA general practice education & training: 2020-21 annual report. Available at https://www.wagpet.com.au/media/11ofj5cb/wagpet-2020-21-annual-report.pdf [Accessed 21 June 2022]

Wieland L, Ayton J, Abernethy G (2021) Retention of general practitioners in remote areas of Canada and Australia: a meta-aggregation of qualitative research. Australian Journal of Rural Health 29, 656-669.
| Crossref | Google Scholar | PubMed |

Wilson M, Mazowita G, Ignaszewski A, Levin A, Barber C, Thompson D, Barr S, Lear S, Levy RD (2016) Family physician access to specialist advice by telephone: Reduction in unnecessary specialist consultations and emergency department visits. Canadian Family Physician 62, e668-e676.
| Google Scholar | PubMed |

Wilson H, Schulz M, Rodgers C, Lintzeris N, Hall JJ, Harris-Roxas B (2022) What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners. Drug and Alcohol Review 41, 1152-1160.
| Crossref | Google Scholar | PubMed |