Improving GPs' skills and competencies in child psychiatry.

Concerned at the poor availability of psychiatric services for children and adolescents, the Finnish Parliament allocated extra funds for their development during 2000 and 2001. With this subsidy, a project was set underway to update general practitioners' (GPs') skills and knowledge in child psychiatry. The problem-based learning (PBL) method was used, combined with multidisciplinary teamwork. The present paper reports on changes Finnish GPs' perceptions of their knowledge and skills in child psychiatry over a 1-year period. The study sample comprised 761 physicians working in health centres in the area of Tampere University Hospital, with a catchment population of one million. GPs' self-assessments of their skills in child psychiatry in 16 areas were collected by postal questionnaire in 2000 and 2001. The response rates were 66.1% and 57.1%, respectively. Those who answered in both years were included in the analysis (n=371). Some GPs felt that their skills and competencies had improved and some that they had declined, while the majority reported no changes. According to logistic regression analysis, the only factor explaining a marked positive change was participation in child psychiatric training. In two areas of competence, GPs who had attended child psychiatric training rated their skills as significantly better than those who had not attended such training. We conclude that the effect of this undertaking was modest when implemented as a one-off training event.

Improving health centre physicians' child-psychiatric networks.

OBJECTIVE: To study changes in Finnish GPs' child-psychiatric networks over a one-year period. DESIGN: Postal questionnaire. SETTING: Health centres in the area of Tampere University Hospital with a catchment population of one million. INTERVENTION: A one-off course in the field of child psychiatry was held 56 times in different health centres. SUBJECTS: GPs (n = 761) working in the area received a questionnaire in 2000 and 2001. Those responding in both years were included in the analysis (n = 371). MAIN OUTCOME MEASURES: A fill-in picture was used to identify professionals in the network of each GP. Three levels were analysed: (1) health centre, (2) municipality, and (3) secondary healthcare. RESULTS: The number of collaborators increased significantly only in the training group at municipality level. No statistically significant differences were found in proportions of GPs naming cooperating persons. CONCLUSION: The impact of a one-off training programme on the scope of GPs' child-psychiatric networks was not very strong but was in accordance with the aims of the programme.

Child psychiatric networks of health centre doctors.

OBJECTIVE: To ascertain the personal networks GPs use when managing children with psychiatric problems. DESIGN: Cross-sectional postal study. SETTING: Health centres in the catchment area of Tampere University Hospital, Finland. SUBJECTS: GPs (n = 755) were sent a postal questionnaire. The response rate was 66.1%. MAIN OUTCOME MEASURES: A fill-in picture was used to identify professionals within the network of each GP. The quality of collaboration between GPs and professionals in health centres, other municipal authorities and secondary health care was assessed on a four-step Likert scale. RESULTS: A majority of respondents (64%) could name at least one person from their health centre with whom they cooperate in child psychiatric cases. The corresponding number in contact with other municipal authorities was 40%, and 25% with secondary care level. Almost all GPs (95%) had mostly positive experiences of cooperation with different professionals in the health centres, 73% with other municipal authorities and 47% with child psychiatric specialist care. CONCLUSION: The personal networks of health centre doctors call for improvement if the increasing child psychiatric problems are to be kept under control. This is a challenge for both primary and secondary care level doctors.