Table 3 Fidelity of each AD session, across the four elements of adherence; challenges raised by GPs in the eight AD sessions, and strategies offered by the GP opinion to address them
Adherence n/N (%) | |||||||||
|---|---|---|---|---|---|---|---|---|---|
Adherence area | Session 1 | Session 2 | Session 3 | Session 4 | Session 5 | Session 6 | Session 7 | Session 8 | |
Duration | 1/1 (100) | 1/1 (100) | 0/1 (-) | 0/1 (-) | 1/1 (100) | 0/1 (-) | 1/1 (100) | 1/1 (100) | |
Coverage | 4/4 (100) | 4/4 (100) | 4/4 (100) | 4/4 (100) | 4/4 (100) | 4/4 (100) | 4/4 (100) | 4/4 (100) | |
Frequency | 2/3 (67) | 2/3 (67) | 1/3 (33) | 3/3 (100) | 2/3 (67) | 1/3 (33) | 2/3 (67) | 3/3 (100) | |
Content | 7/7 (100) | 6/7 (86) | 7/7 (100) | 7/7 (100) | 6/7 (86) | 7/7 (100) | 7/7 (100) | 7/7 (100) | |
Total | 14/15 (93) | 13/15 (87) | 12/15 (80) | 14/15 (93) | 13/15 (87) | 12/15 (80) | 14/15 (93) | 15/15 (100) | |
Issues GP raised (Clinical guideline category) | Strategies proposed by opinion leader GPs | ||||||||
1—What tools can assist a GP in diagnosing and assessing the severity of a MHC | |||||||||
How to diagnose a patient with MHC? How to quantify the severity of a patient’s MHC? | • Encouraged the use of diagnostic tools outlined in the guideline as they have strong evidence recommendations, compared to other questionnaires such as K10, which is relatively less specific • Encouraged to use specific diagnostic tools and questionnaires for different mental health conditions (MHC), such as depression (PHQ-9), anxiety (DASS), post-traumatic stress disorder (PCL-C) • Explained that using diagnostic tools and questionnaires increases the accuracy of diagnosis, as it is difficult to diagnose MHCs compared to ruling out MHCs in the GP setting • Use diagnostic tools in assess and monitor the progression of patients’ MHC over time • Use of diagnostic tools to convey the diagnosis of a MHC to patients, especially when they are hesitant to accept such diagnosis | ||||||||
GP disagrees with some patients’ diagnosis of MHC | • Refer to independent medical practice for assessment • Still introduce management and discuss with patients regarding other factors causing their symptoms • Manage patient emotions, explore if there are underlying reasons for patients to feel/act in this specific way | ||||||||
3—Has the MHC arisen as a result of work | |||||||||
Assessing whether a MHC is work-related | • Consider the temporal relationship when assessing a MHC (i.e. the relationship between work factors and the development of the MHC) | ||||||||
Diagnosing if MHC is work related when: Work injury is related to dynamics of work environment (e.g. workplace bullying) rather than the nature of work | • OP acknowledged that it is difficult to deal with and diagnose the MHC relating to workplace environment • Workplace culture has a big impact of the MHC of employees • Many patients present with MHC because of mistreatment at workplace • May chose to contact workplace with patient consent. Ask for a mediator to raise concerns on behalf of the patient | ||||||||
4—What should GP consider when conveying a diagnosis of mental health condition | |||||||||
Some patients are reluctant to accept MHC diagnosis Raised concerns of diagnosing patients with MHC, as it will be in the medical record and have other unforeseeable implications | • Avoid stigma when explaining and educating the patient regarding the condition and future management • Build therapeutic alliance • Provide information for them to read individually • Arrange next appointment and offer alternatives • Informing the patients of their conditions by explaining the diagnostic criteria and questionnaires | ||||||||
5—How can the condition be managed effectively to improve personal recovery or return to work? | |||||||||
Delays of referring to psychologist and psychiatrists, especially those who accept work cover | • Agreed that it is very difficult, especially in rural areas. Acknowledged that a long wait time is bad for patient’s health • Try to establish personal network with psychologists and psychiatrists • Keep detailed notes and arrange regular appointments with patients • There are once-off consultations at some hospitals (e.g. Bendigo Hospital) • Recommended virtual organisations such as Dokotela • Consider sending patient to emergency if required | ||||||||
What can GPs do if patients are worried about re-injury after return to work? | • Involve independent medical examiner if second opinion is required • Educate patient about the benefits of return to work • Educate patient about the medical system and Workers’ Compensation system • Write detailed physical restrictions at work when talking about alternative duties | ||||||||
10—What can a GP do for a patient whose mental health condition is not improving | |||||||||
How to work with patients who are resistant to management | • Book longer appointments, and make sure to book follow-up appointments • Educate and explain to patients about their MHC • Involve family when necessary • Keep detailed notes about each appointment • It is important for GPs themselves to maintain a positive mindset and understand that they cannot have everything under control all the time • Refer to another GP when necessary | ||||||||
Other: Workers’ Compensation related | |||||||||
What to do when patient is hesitant to apply for Work Cover, e.g. due to concerns such as being discriminated against at workplace, or difficulties finding the next job due to records of Work Cover application | • Close communication with the workplace, with patients’ consent • Determine the state of the patient, ensure patient condition is stable, not at risk of self-harm, etc • Inform workplace and see if things can be resolved prior to submission of Work Cover claims • Keep detailed notes for each appointment • Provide patients with options, and offer to discuss in later sessions | ||||||||
Difficulty managing documentation for sensitive patient information (e.g. drinking abuse) when seeking Workers’ Compensation | • Think carefully regarding what to put into files • Consider confidentiality when communicating with workplace | ||||||||
Difficulty managing patients with chronic/multifactorial MHC when applying for Workers’ Compensation | • Workers’ Compensation has clear exclusion causes, which can be used to rule out • Monitor patient’s symptoms and disease progression as decline in claims may deteriorate the MHC of patients | ||||||||