Doctor of Psycology (Clinical)
School of Psychology
Marshall, Kellie Lynne, GP education in dual diagnosis, Doctor of Psycology (Clinical) thesis, School of Psychology, University of Wollongong, 2007. http://ro.uow.edu.au/theses/2149
General Practitioners are in a unique position to detect and manage patients with comorbid mental health and substance use disorders (dual diagnosis). It has been estimated that over 30% of patients presenting to general practice have a diagnosable mental disorder and 12% have dual diagnosis. Unfortunately, between 30-50% of these problems go undetected in general practice. Limited GP education and training in mental health may account for this deficit. Recognising that general practice is central to mental health care in Australia there has been a surge in mental health training available to GPs. Research has demonstrated that training improves GPs effectiveness in the diagnosis and management of patients with mental health and substance use conditions. However, few studies have examined the impact of more novel modes of training such as online and CD training resources. Furthermore no research has explored factors that are likely to influence GPs uptake of these innovative educational resources. The present study draws on research from the organisational sector that has been more advanced in identifying factors that influence the transfer of training to the work environment.
Prior to the development of an educational resource for GPs there was a need to establish baseline estimates of G P treatment practices with patients who have dual diagnosis. Two GP division-wide surveys of screening, assessment and treatment for dual diagnosis were conducted one year apart. In addition, five GPs conducted a clinical audit of 508 patient consultations. Self-estimates by GPs from the Divisionwide survey indicated that, on average, GPs considered that 13% of their patients have a dual diagnosis. Survey results also indicated that 44% of GPs indicated they "regularly" or "almost always" treated patients with dual diagnosis. However, only 17% of GPs at least "regularly" used screening devices for assessment. The clinical audit found 29% of patients had received treatment for depression, 25% were treated for anxiety and 9% were treated for substance abuse. In total, 34% had received previous treatment for at least one of these disorders and 23%) had previously been treated for more than one of these conditions. Comparisons over time suggested without ongoing targeted interventions, patient management activities such as GP counselling, use of screening devices, referral to specialist services, coordination and use of EPC items are not likely to improve and are at risk of declining.
Study two involved adapting components from the model of Integrative Theory of Training Motivation drawn from organisational psychology and using it to help predict GPs use of a dual diagnosis CD training resource in practice. The study explored the extent that self-efficacy, valence, motivation to learn and intentions to transfer predicted uptake of the CD training resource. The dual diagnosis CD was introduced to 56 GPs across seven workshops. Participants completed pre and post training questionnaires, received copies of the CD and were followed up 5 weeks after training to determine their use of the CD resource. Results showed that self-efficacy, valence, motivation to learn, post-training self-efficacy and intentions to transfer were all positively related but they did not predict GPs use of the dual diagnosis CD training resource. The training context, small sample, measurement issues and associated limited power may have contributed to aspects of the model not being confirmed. Anecdotal findings suggest that more consideration needs to be given to barriers to uptake such as, time availability and environmental cues to CD utilisation.
As use of novel training mediums such as online and CD resources increase, further work in identifying additional factors that support their uptake need to be investigated. Future research will aim to address these barriers and further examine uptake and immediate learning outcomes of training programs utilising this resource.