Preliminary Pilot Study

A pilot phase of the project was run by the author in one Bathurst general practice for one session a week over a period of more than two years (1998-2001). Initial discussions were held with the Mental Health Advisory Committee of the NSW Central West Division of GPs (CWDGP), in which the potential contribution of the psychology discipline at Charles Sturt University (CSU) to local general practices was canvassed. The concept began with observation by the author of two random sessions with volunteer GPs to detect the incidence of psychological impairment amongst patients presenting in the primary care setting. One session entailed seeing 15 patients in a morning; the other 14 patients over a similar time interval. There was clear agreement between the two GPs and clinical psychologist that 60% of patients in the first session had some degree of psychological disturbance amenable to psychological intervention; a 40% prevalence was found in the second group of patients.

It was decided to pilot the provision of clinical psychology services in the General Practice setting in an attempt to both adequately treat the patients’ conditions and to relieve some of the pressure on the general practitioners to deal with such issues.

Service delivery was established one morning a week by the author, and an initial pilot placement was carried out by a senior academic at CSU under the supervision of the author/senior clinical psychologist in fulfilment of Master of Psychology placement requirements at the University of NSW^†. One hundred patients were seen by the author, referred by nine medical general practitioners. During this phase, design features of the main project were finalised.

6.2.1 Patient survey

A brief survey of the first 56 patients seen was carried out to assess their attitudes to and experience of the collaborative service delivery model. Response rates were low (32% - ie. 18 patients returned questionnaires: see Appendix 6.1). However, it was still useful preliminary feedback as it gave some appreciation of how the model was working. Responses were as follows:

• 83% (15) found seeing a clinical psychologist a helpful experience (2 were not sure - all patients being seen at the time, even those at the beginning of their treatment, were sent a questionnaire. Hence, some were not in a position to fully answer some of the questions);

• 78% (14) found their problem improved after seeing the psychologist (again, some were not in a position to fully answer this question for the reasons above);

• 89% (16) said they liked being able to be seen by a psychologist in the general practice setting;

• 72% (13) indicated that they felt more comfortable seeing a psychologist in the doctor’s practice rather than being referred to another practice;

• 89% (16) felt their doctor explained the psychologist’s role to them;

†Clinical placement requirements are set by the Australian Psychological Society College of Clinical Psychologists and entail four full-time placements of 250 contact hours including 50 hours of clinical supervision for the MPsych and the equivalent number of placements with 500 contact hours for DPsych requirements.

• 100% of respondents (6) found the doctor attending the first session with the psychologist helpful (not all patients had experienced this – only 6 patients had the doctor briefly attending the first session);

• 89% (16) found the clinical psychologist easy to talk to;

• 83% (15) indicated that they were given an explanation/understanding of their condition;

• 89% (16) felt involved in their assessment and/or treatment;

• 72% felt they received the right treatment for their presenting problems (some had received only assessment, not treatment, when surveyed);

• 47% (8 out of 17 invoiced) indicated that the fees ($100 per session during the pilot phase of the project) were a problem. Comments on the question: “Did you find fees a problem?” were as follows:

• Need to register clinical psychologists fees with Medicare – this would be of assistance.

• No - but I had to stop because I could not afford it - though I needed help.

• My financial situation did not allow me to pay full fees - adjustments were made for which I am extremely grateful.

• People who are on a pension or financially challenged have a major problem with the cost.

• The fee was tailored to help me (which it did) but I still found it difficult to pay. I would have gone more if I could have afforded it.

• Yes, they were a problem but (the psychologist) was very good to me about my fees. I could not to keep up with the full fee each time.

• I had them paid as a workers compensation matter.

6.2.2 GP survey

The nine referring doctors involved in the preliminary phase of the project were similarly surveyed to assess their perception of working with a clinical psychologist over this period of time (for questionnaire see Appendix 6.2). Only six (66%) of the doctors responded – however, these were those most closely involved in establishing

the trial in the first place and hence had most experience of it. Their responses were as follows.

6.2.2.1 “Value to patients”

• 100% (6) of doctors believed their patients had benefited from the extra professional support and counselling;

• 100% (6) indicated that management of patients with both acute and non-acute emotional/psychological disturbance had improved;

• 83% (5) agreed their patients exhibited an improvement in/healthier behaviour patterns (as with the patient survey, some patients had not completed treatment at the time of survey);

• 100% (6) indicated that their patients had received cost effective psychological services.

6.2.2.2 “Value to GPs”

The doctors indicated the following:

• 100% (6) said that they:

i) benefited from the personal support/sharing care with a clinical psychologist;

ii) found the opportunity to introduce their patient to the psychologist valuable;

iii) found that the clinical psychologist provided a valuable option for more accessible psychological services;

iv) would like to see the “Clinical Psychologist in General Practice Project” continue in their practice.

• 83% (5) indicated that:

i) they benefited from the collaboration in developing a “case management model of care”;

ii) their skills and confidence in working with patients with emotional/psychological disturbances had increased;

• 83% (5) said that the clinical psychologist reduced the amount of time they needed to spend with particular patients.

(All responses in this section were either in the “strongly agree/agree” range – as outlined above – or in the “not sure” category.)

6.3 Design