Academic journal article Australian Health Review

The Mental Health Nurse Incentive Program: Reactions of General Practitioners and Their Patients

Academic journal article Australian Health Review

The Mental Health Nurse Incentive Program: Reactions of General Practitioners and Their Patients

Article excerpt

Introduction

The National Action Plan on Mental Health (2006-2011) pro- motedseveral initiatives designedto improveintegration between primary care and specialist mental health services in Australia.1 The Mental Health Nurse Incentive Program (MHNIP) was one of the initiatives introduced in July 2007 to provide better access to primary care for those individuals with severe mental health problems. The program enables GPs, psychiatrists and divisions of general practice to employ mental health nurses (MHNs) to assist with the coordination and treatment of those with severe mental health problems.

Under the program guidelines MHNs are expected to work in collaboration with GPs to provide a suite of interventions aimed at enhancing continuity of patient care. These interventions are likely to include the planning of patient care, providing periodic reviews of the patient's mental state, monitoring medication and linking patients to other health professionals and services. These treatment options can be provided in a range of settings, such as GP clinics and community settings, such as patients' homes.2 While there is no limit to the amount of time that a MHN can devote to individual patients, it is expected that a full-time nurse will provide up to 10 sessions (of 3.5-h duration) per week and will carry a case load of around 20 patients.

In 2009, Medicare Australia reported that in the two years since the initiative commenced, 28 599 people across Australia had accessed the program and that 136 706 face-to-face occa- sions of services had been provided.3 A year later in 2010, the number ofpeoplewhohadaccessedtheprogramhadincreased by 86%, with the number of face-to-face contacts having more than doubled. While the MHNIP has had a significant impact on the way in which GPs approach the treatment of those with mental illness, there is a paucity of published studies on how GPs and their patients view the program.

Method

The findings reported here form part of a larger evaluation of the MHNIP conductedbetween2008and 2010 in and aroundthe city ofIpswich inQueensland.The data are derivedfromadescriptive study approach using focus group discussions with 25 GPs and individual telephone interviews with 19 patients. The evaluation was approved by West Moreton Health Service District Ethics Committee.

Procedure

The discussion groups with GPs were held during lunchtime and all GPs working in the practice at that time were invited to attend. Of the 31 GPs on duty at the time of data collection, 25 participated in the focus group discussions. The remainder were busy with patients and were unable to attend. The discussions ranged in duration from 40-55 min and were facilitated by a psychologist who had no involvement in the MHNIP. Patient interviews (n = 19) were conducted by telephone. All patients consenting to be involved in the evaluation were asked if they would be willing to participate in a telephone interview with a member of the evaluation team. Of the patients consenting to interview, four were randomly selected from the case load of each of the five nurses involved (one patient refused to be interviewed).

While the discussion topics for both groups were driven by a list of questions set out in a semi-structured interview schedule, spontaneous feedback was welcomed and encouraged. Question- ing focussed on: (i) overall perceptions of the MHNIP, (ii) issues and concerns and (iii) perceived benefits of the program.

Data analysis

All discussions groups and interviews were audio recorded and transcribed verbatim. Transcriptions were checked for errors against the taped version to ensure accurate and authentic repro- duction. Content analysis was employed to guide analysis of the transcripts.4 The transcripts for each group were reviewed several times to acquire a sense of flow and to generate a list of key ideas and words that reflected the sentiments of the data. Units of information that related to the same content were brought together and preliminary categories developed. …

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