Abstract
Objective
To compare the performance of the general practitioners (GPs) in a collaborative care (CC) program in Iran with a control group of GPs in the usual care by employing simulated patients.
Methods
Six trained simulated patients (SPs) made unannounced visits to 26 GP offices participating in the CC program and to 26 age and sex matched controls. The SPs role played five clinical scenarios of mental disorders and filled out checklists to evaluate the GPs’ performance regarding interviewing, taking history, establishing rapport, showing empathy, and giving advice to patients. Additionally, the GPs’ plan of care and prescriptions were evaluated later by a psychiatrist based on the documents provided by the SPs.
Results
There was a significant difference between collaborative care and control group physicians in their global performance; CC physicians built up better patient–physician relationship. They performed better in evaluating a psychotic patient, although not better in their management. CC physicians were marginally better in approach to patients with generalized anxiety disorder (GAD) and mild major depressive disorder.
Conclusion
The overall performance of physicians in CC was better than the GPs in the control group in making an effective patient–physician relationship, and evaluating a psychotic patient. The main weakness of the GPs was in proper treatment of the minor and more common psychiatric disorders and in evaluation of patients with suicidal ideations who were in need for emergent referral. Evaluating performance of the practitioners is feasible employing SPs and the findings can be translated into improvements in the available services.
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Acknowledgments
This study was support by a Grant (No. 91-04-30-20052) from the Ministry of Health and Tehran University of Medical Sciences and Health Services in Iran. The authors wish to acknowledge the contributions of Ms. Zahra Noee and Dr. Leila Kashani to conduct the study, and Dr. Maryam Abbasinejad to edit the manuscript, respectively. We are particularly grateful to those who participated in the study as SPs.
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Amini, H., Shakiba, A., Sharifi, V. et al. Evaluation of the performance of general practitioners in a collaborative care program by employing simulated patients. Soc Psychiatry Psychiatr Epidemiol 51, 1311–1319 (2016). https://doi.org/10.1007/s00127-016-1226-3
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DOI: https://doi.org/10.1007/s00127-016-1226-3