Collaboration with Clinical Psychologist in the Management of Common Mental Disorders in Family Medicine Specialist Clinic (FMSC) - A Three Year Experience

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Authors (including presenting author) :
Cheng SYR(1), Tse HC(1), Wan MP(2), Lam V(2), Ho C(2), Liang J(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, New Territories West Cluster; (2)Department of Clinical Psychology, Tuen Mun Hospital
Introduction :
Depression and anxiety disorder are the common mental disorders seen in FMSC setting. Collaboration with Clinical Psychologist (CP) intervention was commenced in Feb 2015 in POH FMSC for the management of these patients.
Objectives :
1)To support Family Medicine doctors in managing common mental disorders with early CP intervention 2)To improve outcomes of patients with common mental disorders 3)To reduce the psychiatric referral rate
Methodology :
FMSC patients who were found to have common mental disorders like depression and anxiety, were arranged to see both CP and FM doctor in subsequent follow-up. Patients who attended ≥ 2 CP and FM doctor sessions were included for the review. Patients’ PHQ -9 and GAD-7 score were retrieved for outcome analysis. Patients’ diagnosis and discharge destination would also be analyzed.
Result & Outcome :
From Feb 2015 to Jun 2018, 65 patients had attended ≥ 2 CP and FM doctor sessions. Female to Male ratio was 56:9. 43 out of 65 patients had other comorbidities follow-up in FMSC as well. Patients’ diagnosis were: (may be more than 1 diagnosis for each patient) Depression: 22 (33.8%); Anxiety disorder: 26 (40%); Adjustment/Stress reaction: 14 (21.5%); Dysthymia: 8 (12.3%); Panic Disorder: 5 (7.7%). Till Jun 2018, 44 patients were discharged from the program, the discharge destination was: FMSC: 27(61.4%), Psychiatry: 1 (2.3%), No FU: 16 (36.4%). The PHQ-9 score and the GAD-7 score of patients at the time of joining the program and at discharge were compared. For PHQ-9 score, 75% of patients showed reduction in PHQ-9 score, 15.9% remained the same. For GAD-7 score, 70.5% of patients showed reduction in GAD-7 score, 6.8% remained the same. Mean PHQ-9 score at the time of joining the program was 11.2, and reduced to 8.5 at discharge. Mean GAD-7 score at the time of joining the program was 10.7, and reduced to 7.8 at discharge. In conclusion, the collaboration with CP for the management of common mental disorders in FMSC improves the patient's clinical outcome with significant reduction in patient's PHQ-9 and GAD-7 score. It also reduced the need of psychiatric referral.

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