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Psychiatry out-of-hours: a focus group study of GPs' experiences in Norwegian casualty clinics

DOI: 10.1186/1472-6963-11-132

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Abstract:

We conducted a qualitative study based on two individual interviews and six focus groups with purposively sampled GPs (totally 45 participants). The interviews were analysed successively in an editing style, using a thematic approach based on methodological descriptions by Charmaz and Malterud.Safety and uncertainty were the dominating themes in the discussions. The threat to personal safety due to unpredictable patient behaviour was a central concern, and present security precautions in the out-of-hours services were questioned. The GPs expressed high levels of uncertainty in their work with patients presenting problems related to mental illness or substance abuse. The complexity of the problems presented, shortage of time, limited access to reliable information and limited range of interventions available during out-of-hours contributed to this uncertainty. Perceived access to second opinion seemed to have a major impact on subjectively experienced work stress.The GPs experienced out-of-hours psychiatry as a field with high levels of uncertainty and limited support to help them meet the experienced challenges. This might influence the quality of care provided. If the current organisation of emergency mental healthcare is to be kept, we need to provide GPs with a better support framework out-of-hours.In countries with two-tier public healthcare systems there is a debate over how to best provide emergency psychiatric care [1,2]. Some countries, like Norway, adhere to a system where general practitioners (GPs) are gatekeepers for all specialised care [3,4]. Thus in Norway regular general practitioners (RGPs) provide emergency psychiatric care for their enlisted patients during office-hours [5], and they are responsible for onwards referral of patients in need of emergency psychiatric care at a more specialised level. Out-of-hours, emergency primary healthcare is the responsibility of local municipalities [6]. This requirement is normally met by organising a casualty

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