A qualitative study involving 38 semi-structured telephone interviews was conducted with GPs, psychiatrists and compensation scheme workers in 2016. The study sought to understand challenges faced by GPs’ in the diagnosis and management of patients with work-related mental health conditions presenting in general practice. Findings will be used to assist in the development of NHMRC-approved clinical practice guidelines in this area.
As we move into 2017, the mental health guidelines project is well underway.
Our emphasis for this year will include undertaking systematic reviews, drafting guideline recommendations, piloting the drafted clinical practice guidelines (hereafter referred to as ‘the guidelines’), establishing an Implementation group and preparing papers for publication and presentation at upcoming conferences.
The project team have begun screening literature via Covidence (read further for more detail about this platform). Then the Guideline Development Group will use the GRADEsystem to appraise the literature gleanedthrough the reviews to determine and inform draft guideline recommendations. Once the recommendations and clinical practice guidelines have been drafted, the guidelines will be released for public consultation to assess their applicability and usefulness. Feedback received will be used to modify the guidelines.
The project team will establish an Implementation group whose primary role will be to oversee the development of an implementation plan for the guidelines (more information on the Implementation group has been provided further down).
Throughout the course of the year, the project team will prepare papers for publication. We also aim to disseminate findings from the project at upcoming conferences including GP17 hosted by the Royal Australian College of General Practitioners (RACGP), the Primary Health Care and Research Information Service (PHCRIS), Guidelines International Network (G-I-N), and Evidence Based Health Care (EBHC) in 2017.
Systematic Literature Reviews Ten systematic literature review questions were determined by the Guideline Development Group. Literature pertaining to each question will be screened using Covidence. Questions include:
In workers presenting with symptoms of mental health conditions, what tools can assist a GP in making an accurate (sensitive and specific) diagnosis of, and severity of mental health disorders?
In patients with a diagnosed mental health condition, what methods are effective at indicating the probability that the diagnosed mental health condition has arisen as a result of work?
In workers, what factors assist in the early detection of a work-related mental health condition?
In patients with work-related stress, what GP strategies result in the highest levels of personal recovery and return to work?
In patients with a diagnosis of a work-related mental health condition, what factors lead to delayed progress in the patient's condition?
In patients with work-related mental health conditions who are not improving, what strategies should GPs undertake to improve the patient's condition?
For GPs who are managing patients with compensation claims, what is appropriate communication with the patient's workplace, in order to appropriately investigate and manage a work-related mental health condition?
When conveying a diagnosis of a work-related mental health condition to a patient, what factors should GPs consider to ensure that their diagnosis is understood and acknowledged by the patient?
In patients with work-related mental health conditions, what interventions are effective at managing comorbid substance misuse and addictive disorders by GPs?
In workers, what information should a GP consider to determine whether a person is capable and has capacity to (return to) work?
After titles and full text articles are reviewed, relevant literature will be extracted and drawn upon to support the formulation of guideline recommendations.
Covidence is an online software platform used for healthcare evidence synthesis including systematic reviews and Cochrane reviews. It is a leading tool for primary screening and data extraction, commonly used by Cochrane authors and other systematic literature review developers. The online platform aligns with the key steps of the Cochrane review process:
1. Citation screening (this included an evidence reviewer and project officer independently screening titles and abstracts of articles to determine whether they were relevant to the systematic literature review question at hand, a number of irrelevant articles were excluded)
2. Full text review (remaining articles underwent further screening. The full text of each article was reviewed, this process eliminated more articles found to be irrelevant).
3. Risk of bias assessment (throughout the screening process an evidence reviewer and project officer were blinded to one another's responses, therefore risk of bias assessment was eliminated).
4. Extraction of study characteristics and outcomes. Remaining studies will be exported from Covidence, relevant data from each article will then be entered into evidence tables.
5. Data and references will then be exported into Revman for analysis
The online platform has been designed to support highly efficient production of systematic reviews and therefore we have chosen to use Covidence in our project.
Complexities of diagnosing and managing
work-related mental health conditions
Between Nov 2016 and Jan 2017 In 2016, we collected data from general practitioners, psychiatrists and compensation scheme workers about their own experiences and perceptions of the GPs role in managing and diagnosing patients with work-related mental health conditions and to identify gaps where future guidance would be usefulto maximise coding and to help us determine the scope for the forthcoming guidelines.
Our summer scholar student, Eli Ivey along with Project Officer, Jacinta Clements undertook a thematic analysis of this data to inform comprehensive view of the clinical issues and system issues involved in management and diagnosis of work-related mental health conditions. This extended analysis revealed four overarching themes:
1) GP difficulties with diagnosis, specifically which diagnostic tools might be relevant, difficulty in determining the severity and work-relatedness of a patient's mental health condition, ensuring diagnostic accuracy, and the implications of labelling the patient as having a mental health disorder.
2) GP management challenges. For example, dealing with patient attitudes concerning return to work, and concerns about the implications of managing mental health conditions through a compensation scheme and claims process.
3) Uncertainty about the GP role in the compensation scheme process and the role of other health professionals and compensation scheme personnel.
4) Difficulties navigating the compensation system.
We thank Eli for his work on this.
Evidence Reviewer, Mr Tshepo Rasekaba
We welcome Tshepo Rasekaba, a Research Fellow in the Department of General Practice. Tshepo will be responsible for designing and undertaking the evidence reviews for the clinical practice guidelines for the diagnosis and management of work-related mental health conditions. He has an interest in health services and clinical research that informs chronic disease management, particularly diabetes, across primary and tertiary care.
Tshepo has undertaken work in Hospital Admission Risk Program evaluation including service utilisation and outcomes in type 2 diabetes, hospital intensive care unit mortality monitoring using the Critical Outcome Prediction Equation in Victorian public hospital ICUs. His PhD research (which is currently undergoing assessment) explored a telemedicine intervention in the management of insulin treated gestational diabetes.
Tshepo is a generalist researcher keen on applying his experience and research skills in evidence based clinical practice, healthcare program development, implementation and evaluation to impact service and patient outcomes.
Our aim in producing these guidelines is to improve the care for people with work-related mental health conditions. As part of this, an Implementation group will be formed to develop a comprehensive guideline dissemination plan, consider key issues regarding marketing and implementation of the guideline.
As always, we welcome interest from workers, clinicians and organisations with an interest in work-related mental health conditions. Should you wish to find out more information about the project or be involved in piloting of the guidelines, please contact the Project Manager, Dr Samantha Chakraborty (details provided below).