Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia
Exploring General Practitioners' Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia
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DOI：
10.3390/ijerph15122763
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发表时间：
2018-12-01
影响因子：
--
通讯作者：
Litt, John
中科院分区：
文献类型：
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作者：
Wlodarczyk, Julian;Lawn, Sharon;Litt, John
在初级保健中寻求边缘性人格障碍 (BPD) 治疗的人群的患病率是普通人群的四到五倍。因此，全科医生（GP）是这些患者评估、诊断、治疗和护理的重要来源，也是心理健康和相关合并症早期干预和长期管理的重要提供者。对南澳大利亚 12 名全科医生组成的两个焦点小组进行的主题分析（与 10 名学术、临床和生活经验利益相关者进行讨论）强调了全科医生为 BPD 患者提供护理时面临的许多挑战。主要主题是：(1) BPD 诊断面临的挑战； (2) 合并症和临床复杂性； (3) 患者行为和全科医生与患者关系方面的困难； (4) 寻找和导航支持系统。这一高风险/高需求患者群体的健康服务途径取决于全科医生提供的护理质量，而这又取决于全科医生识别和理解 BPD 的能力。全科医生还需要得到充分的支持，以培养为 BPD 患者提供有效护理所需的技能。系统性障碍和医疗保健政策，在某种程度上决定了初级保健的组织，是阻碍全科医生尝试解决 BPD 患者多种合并症的突出结构性因素。建议采取多种策略来支持全科医生支持 BPD 患者。
The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP-Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs' capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs' attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.