Diagnostic and treatment challenges of patients in the Danish Primary Sector, who experience acute decline of social and cognitive capabilities due to psycho-social stress - A Literature Study
Author
Sønderby, Steen David
Term
5. Term (Master thesis)
Education
Publication year
2021
Abstract
Baggrund: Patienter med psykosocialt stress, der oplever nedsat social og kognitiv funktionsevne, udgør en betydelig del af strømmen til almen praksis, og konsultationer om mental sundhed er ofte længere og mere komplekse. Denne litteraturundersøgelse havde til formål at belyse, hvordan denne patientgruppe beskrives i studier fra dansk almen praksis, samt at identificere diagnostiske, behandlings- og henvisningsmæssige udfordringer og mulige strukturelle barrierer. Metode: Der blev gennemført en systematisk søgning i PubMed, Embase og PsycInfo uden sprog- eller årbegrænsning. Studier blev inkluderet, hvis de omhandlede patienter med psykosocialt stress i dansk almen praksis; studier med primært svær psykiatri uden for affektiv/angstspektret, alvorlig somatisk komorbiditet, børn eller geriatriske populationer blev ekskluderet. I alt blev 2081 referencer identificeret, 1305 screenet efter dubletfjernelse, 84 læst i fuld tekst, og 15 kvalitative studier om almen praksis-lægers erfaringer indgik i den tematiske, induktive analyse. Kvalitetsvurdering blev foretaget med CASP og VAKS. Resultater: Læger i almen praksis beskrives som gode til at relatere patienters symptomer til livsomstændigheder og stressorer; flere kvinder end mænd søger læge med sådanne problemer, ofte relateret til arbejde eller familie. Gennemgående udfordringer omfatter tids- og ressourcepres, begrænsede muligheder for at tilbyde samtaleterapi og strukturerede forløb, usikkerhed og bekymringer om henvisnings- og samarbejdsmuligheder på tværs af sektorer samt manglende undervisning og øvelse i samtale-, kognitiv og mentaliseringsbaseret terapi. Der peges også på strukturelle barrierer, herunder afregnings-/ydelsesforhold. Konklusion: Den kvalitative litteratur er begrænset, men peger konsistent på, at almen praksis møder betydelige tids-, kompetence-, henvisnings- og strukturelle udfordringer i håndteringen af patienter med psykosocialt stress og nedsat social/kognitiv funktion. Samtidig er læger tilbageholdende med at tildele psykiatriske diagnoser og kontekstualiserer symptomer i patientens livssituation, hvilket understreger behovet for klare forløbsveje, bedre adgang til relevante tilbud og målrettet efteruddannelse i lyset af opdaterede kliniske retningslinjer.
Background: Patients experiencing psychosocial stress with a decline in social and cognitive functioning constitute a substantial part of Danish general practice, and mental health consultations are often longer and more complex. This literature study aimed to clarify how this patient group is described in studies from Danish general practice and to identify diagnostic, treatment, and referral challenges as well as potential structural barriers. Methods: A systematic search was conducted in PubMed, Embase, and PsycInfo without language or year restrictions. Studies were included if they concerned patients with psychosocial stress seen in Danish general practice; studies focusing on severe mental disorders outside the affective/anxiety spectrum, severe somatic comorbidity, children, or geriatric populations were excluded. In total, 2081 records were found, 1305 were screened after duplicate removal, 84 were assessed in full text, and 15 qualitative studies on general practitioners’ experiences were included for thematic, inductive analysis. Quality appraisal used CASP and VAKS. Results: General practitioners (GPs) are described as skilled at linking patients’ symptoms to life circumstances and stressors; more women than men present with such problems, often related to work or family. Recurring challenges include time and resource constraints, limited capacity to provide talking therapies and structured care pathways, concerns about referral options and cross-sector collaboration, and insufficient training and practice in conversational, cognitive, and mentalization-based therapies. Structural barriers, including remuneration/fee structures, were also noted. Conclusion: Although the qualitative evidence base is limited, it consistently indicates substantial time, competency, referral, and structural challenges in managing patients with psychosocial stress and reduced social/cognitive functioning in general practice. At the same time, GPs are cautious about assigning psychiatric diagnoses and contextualize symptoms within patients’ life situations, highlighting the need for clear care pathways, better access to appropriate services, and targeted continuing education in step with updated clinical guidelines.
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