PCPs Doubt Their Own Abilities to Treat Patients with Mental Illnesses

Their doubts may negatively affect their interest in creating teams of specialized physicians to help those patients.

Many primary care physicians (PCPs) harbor doubts about their ability to effectively treat patients with mental illness, and those doubts may negatively affect their interest in establishing team-based care regimens for those patients, according to a survey of 402 Colorado-based PCPs.

The survey, led by Danielle Loeb, MD of the Division of General Internal Medicine at the University of Colorado, found that since PCPs treat more than half of all patients with mental illness, a PCP’s confidence in their own ability to diagnose, treat, and provide referrals to specialists is crucial in establishing communication between disparate healthcare providers like psychiatrists or therapists, which creates a team-based approach to mental illness treatment.

Along with colleagues, Loeb designed the series of 3 self-efficacy surveys to evaluate PCP's beliefs about their ability to adopt the role of primary care provider for patients with mental illness. Loeb and colleagues believe that high levels of PCP self-efficacy associated with mental health care likely influences the degree to which PCPs engage in the activities necessary to treat mental illness in their patients, and participate meaningfully in team-based care.

Measuring the self-efficacy of PCPs, according to Loeb's research, should "help assess the success of interventions aimed at increasing physician engagement in treatment of mental illness and in team-based care," and may indicate PCPs willingness and readiness to assist with mental health management for patients in their care.

Loeb’s mail survey asked primary care providers to respond to 2 general questionnaires on mental health knowledge and communication strategies, as well as 3 self-efficacy scales constructed by the researchers which center on management of chronic medical illness (CMI), mental illness management (MIM), and participation in team-based care (TBC).

The TBC scale is based on the extant National Committee for Quality Assurance (NCQA) Patient Centered Medical Home 2011 scale which addresses communication within the team, care coordination, population management, self-management support, and continuity of care. The MIM scale is designed to provide data on self-efficacy related to PCPs' involvement in diagnosing and treating a range of mental illnesses, but focuses on treatment of depression, generalized anxiety disorder, and bipolar depression — three mental illnesses which, according to research data presented by Loeb and colleagues, are more commonly treated in primary care settings.

The last of the three self-efficacy scales, the CMI scale, provides a benchmark against which the MIM could be contrasted. The two additional questionnaires were modeled on the Mental Health Knowledge and Management Instrument, and Asbury's Physician Confidence with Communication Strategies survey.

The expected outcomes of the survey were that PCPs would rate their self-efficacy for the MIM lower than that of the CMI, and that PCP participation in TBC would be effected. Data confirmed that the MIM scale was correlated to use of TBC for mental health in PCPs. Those PCPs who were uncertain about their efficacy in treating and diagnosing mental illness were notably less willing to participate in team-based care for their patients with mental illness.

According to Loeb, the TBC scale is useful as a tool to not only monitor engagement, but PCP transformation, noting that PCPs are often reluctant to shift away from “physician-centric care” into a collaborative model. A TBC approach to chronic illness is common among PCPs, but the survey found that more resistance, linked to a lack of confidence in their ability to treat mental illnesses, may be associated with a lack of TBC for patients with mental health issues.

"Transitioning from one-on-one doctor-patient relationships to team models of care for patients with mental illness requires a significant change in the PCP role from the traditional patient-physician relationship," Loeb and colleagues wrote, concluding that PCPs are a vital part of team based care, serving as the hub for patients with mental illness.

The article "Development and Initial Validation of Primary Care Provider Mental Illness Management and Team Based Care" appeared in the March-April 2017 issue of General Hospital Psychiatry.

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