Anjara, S. G., Bonetto, C., Ganguli, P., Setiyawati, D., Mahendradhata, Y., Yoga, B. H., … & Van Bortel, T. (2019). Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial. PloS one, 14(11), e0224724.
Many experts have suggested integrating mental health care into primary care to help bridge the mental health care gap. General practitioners (GP) are the first healthcare worker to be called upon to treat patients with mental disorders. In Indonesia, the WHO mhGAP has been systematically introduced to a network of 10,000 primary care clinics as additional mental health training for doctors and nurses pairs, since late 2015. In one of 34 provinces, there is an integrated care model: co-location of clinical psychologists in primary care clinics. This study evaluated the outcomes of patients who were given mental health care by General Practitioners and those treated by clinical psychologists in primary care.
This study used a partially randomized, pragmatic, partial randomized two-group cluster non-inferiority trial, 14 primary care clinics assigned to receive WHO mhGAP training, and 14 clinics with a joint site framework (co-location) assigned to specialists. All adult primary care patients who screened positive for psychiatric morbidity were eligible. Doctors offer psychosocial and/or pharmacological interventions and Clinical Psychologists offer psychosocial interventions. Primary outcomes were health and social functioning as measured by HoNOS and secondary outcomes including disability as measured by WHODAS 2.0, health-related quality of life as measured by EQ-5D-3L, and resource use and costs evaluated from a health care perspective at six months.
This study showed the results of GP treatment proved statistically equal to clinical psychologists in reducing symptoms of social and physical disorders, reducing disability, and improving mental health-related quality of life at six months. The economic analysis shows lower costs and better outcomes by specialist treatment and suggests a 50% likelihood of the WHO mhGAP framework being cost-effective given Indonesia’s willingness to pay the per QALY threshold.
Based on the results of this study, general practitioners who are supported by nurses in primary care clinics can effectively treat mild to moderate mental health problems that are common among primary care patients. They provide non-stigmatized mental health care in a community context, thus helping to reduce the mental health care gap.