Consultations in general practices with and without mental health nurses: an observational study from 2010 to 2014

OBJECTIVES To investigate care for patients with psychological or social problems provided by mental health nurses (MHNs), and by general practitioners (GPs) with and without MHNs. DESIGN An observational study with consultations recorded by GPs and MHNs. SETTING Data were routinely recorded in 161-338 Dutch general practices between 2010 and 2014. PARTICIPANTS All patients registered at participating general practices were included: 624 477 patients in 2010 to 1 392 187 patients in 2014. OUTCOME MEASURES We used logistic and Poisson multilevel regression models to test whether GPs recorded more patients with at least one consultation for psychological or social problems and to analyse the number of consultations over a 5-year time period. We examined the additional effect of an MHN in a practice, and tested which patient characteristics predicted transferral from GPs to MHNs. RESULTS Increasing numbers of patients with psychological or social problems visit general practices. Increasing numbers of GPs collaborate with an MHN. GPs working in practices with an MHN record as many consultations per patient as GPs without an MHN, but they record slightly more patients with psychological or social problems (OR=1.05; 95% CI 1.02 to 1.08). MHNs most often treat adult female patients with common psychological symptoms such as depressive feelings. CONCLUSIONS MHNs do not seem to replace GP care, but mainly provide additional long consultations. Future research should study to what extent collaboration with an MHN prevents patients from needing specialised mental healthcare.