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Does a continuing medical education course in mental health change general practitioner knowledge, attitude and practice and patient outcomes?

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Background Approximately 25% of patients attending general practice have a psychiatric disorder, most commonly depression and anxiety. Many of these disorders go undetected and untreated. In order to assist general practitioners (GPs) detect and manage mental illness the University of Melbourne and Monash University collaborated to develop a one-year graduate certificate in general practice psychiatry. This paper details an evaluation measuring the impact of the course on change in GP knowledge, attitude and clinical practice, and patient outcome.

Method A controlled before-and-after design was used with 14 participants matched to 14 control GPs. Knowledge and attitudes were measured at course commencement, 12 months and 18 months. Clinical behaviour was measured using clinical audit simultaneously with patient self-report (using the GHQ and SF-36) before and after the course.

Results The course had a positive impact on GPs' knowledge of depression and anxiety with further improvement evident six months after completing the course. Comfort and competency of participants' detection and treatment of depression and anxiety improved significantly six months post-course. There was no change in GP recognition of cases with all GPs continually identifying 51% of 'probable cases'. Similarly, there was no significant effect of the course on overall prescribing habits, non-drug management or referral of 'probable cases'. Patients tended to improve over a ten-week period (on GHQ and SF-36 scores) with improvement rates the same pre- and post-course.

Conclusion Continuing medical education (CME) resulted in sustained changes in doctors' knowledge and attitude. Change in clinical practice was not generally discernible, and may depend on a combination of knowledge, attitude and skills as well as on socio-political forces beyond the reach of a CME programme.


Document Type: Research Article

Publication date: March 1, 2004

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