Quality Measures Database

A condition in which a person has both a major mental illness and another health problem (e.g., development disability, substance abuse, personality disorder, or other general medical conditions such as heart disease or cancer).
Additional Domain(s) : Accessibility, Patients with Substance Abuse

Specialist services are effective for relapse prevention if offering behavioural self control training, motivational enhancement therapy, family therapy/community reinforcement approach and/or coping/communication skills training
The GPs decision where to refer a patient should be guided in large part by the patients choice. Some predictors however, have emerged: patients who are angry at the initial assessment appear to do better, in the short term, if given motivational interviewing
Patients with psychiatric disorders (dual diagnosis) tend to do better if referred to specialist psychological or psychiatric services than to 12-step Alcoholics Anonymous (AA) groups. Patients referred to specialist care, who live or work in environments where there is a lot of drinking and little support for abstinence, may do better in a service which offers consultations which emphasize the 12-step AA approach, rather than specialized psychological therapy.
One underpowered study found no advantage to specialist treatment over general practice management in the UK. Two North American studies have shown that milder alcohol dependence can sometimes be successfully managed without specialist care. However, brief primary care intervention has usually excluded alcohol dependent patients who should, in general, be referred for specialist care.

Drummond DC, Thom B, Brown C, Edwards G, Mullan MJ. Specialist versus general practitioner treatment of problem drinkers.
Lancet. 1990 Oct 13;336(8720):915-8.
PMID: 1976937

I: Consistently higher quality studies specifically focused on primary mental health care.

• PH doesn’t control access - but we can and do certainly refer patients to these services
• Good idea but not easily put into practice or easily measured
• Relapse prevention indentification is a key PHC role.

Ratings-based Rank Relevance 9 Actionability 33 Overall Importance 21		Stakeholder Rank Academics 26 Clinicians 6 Consumers 23 Decision Makers 30 �		Special Group Rank First Nations 48 Rural Areas 41 Federal Stakeholders 60
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 27 21 12 28 41 21 5 5 5 95 20 47 105				Overall Rank        19