General practitioners' working in primary care teams' perceptions of the community mental health team for older people service provision in a rural health service executive region / thesis by Margaret Kerlin

摘要

The purpose of this research study was to conduct a study to explore General Practitioners’ (GPs) expectations and views of the service provided by the Mental Health Service for Older People and identify areas for improvement. The study set out to determine whether or not the service provided meets the perceptions and expectations of GPs. Their experiences and views are explored regarding this specialist service. The study aimed to highlight the training needs of GPs in managing older people with mental health problems. The launch of the Health Transformation Programme 2007-2010 (HSE, 2006) has challenged services to radically change the way managers organise and deliver services. People are now living longer, populations are increasing and getting older, expectations and demands for services are increasing (Mental Health Commission, 2007). The new Mental Health Policy document, A Vision for Change (VOC), (DoHC, 2006) acknowledges MHSOPs are a recent service development within Ireland when compared to the United Kingdom (UK). The main principle for the development of this specialist service in Ireland relates to older people’s right to access the most appropriate service to their needs (Graham et al., 1988). The MHSOP was established six years ago in a rural HSE region. It is a fully multidisciplinary team and it has the minimum compliment of allied professionals in the team, as recommended in the VOC strategy (DoHC, 2006). The service model delivered by this team is in keeping with the most widely accepted model for MHSOP (Jolley & Arie, 1978). A qualitative exploratory study design was used to investigate this area. The perceptions and experiences of six GPs who worked in one of three PCTs in a rural HSE region were investigated using semi-structured interviews that lasted on average thirty minutes each. The interview transcripts were analysed thematically using King’s (1989) template approach. Three main themes emerged from the analysis: expectations of the MHSOP, perceptions and experiences of the service delivery and areas for improvement by the service. The main findings suggest that the MHSOP is perceived positively by the GPs as a valuable specialist service to access for support in managing patients’ care. In general, GPs perceive that the service improves quality of care to this patient group. The majority of participants strongly support the need for the service and others expressed positive views of the effectiveness of the service provided. In addition the main findings indicate that closer collaboration and communication between both services could be enhanced and further developed by introducing referral guidelines. iii udIt is envisaged this piece of research will provide a basic understanding of what GPs expectations are of a MHSOP. This will provide significant information for other MHSOPs who will provide care in conjunction with their Primary Care Team. Recommendations are identified from the study findings. Several changes need to be made in the operational processes and service developments to make the MHSOP more effective. Recommendations for future developments to the service are also provided and training needs identified by the GPs.