Demand and supply for psychological help in general practice in different European countries: access to primary mental health care in six European countries.

The general practitioner is usually the first health care contact for mental problems. The position of a general practitioner may vary between health care systems, depending on the referral system (gatekeepers versus directly accessible specialists), presence of fixed lists and the payment system. This may influence patients' expectations and requests for help and GPs' performance. In this paper the effects of working in different health care systems on demand and supply for psychological help were examined. Methods: Data were collected in six European countries with different health care system characteristics (Belgium, Germany, the Netherlands, Spain, Switzerland and the UK). For 15 consecutive contacts with 190 GPs in the six countries, each patient completed questionnaires concerning reason for visit and expectations (before) and evaluation (after consultation). General practitioners completed a general questionnaire about their personal and professional characteristics as well. Results: Practices in different countries differed considerably in the proportion of psychological reasons for the visit by the patient and psychological diagnoses by the GP. Agreement between patients' self-rated problems and GPs' diagnoses also varies. Patients in different countries evaluated their GPs' psychological performance differently as well, but evaluation was no correlated with agreement between request for help and diagnosis. In gatekeeping countries, patients had more psycho-social requests, GPs made more psychological diagnoses and agreement between both was relatively high. Evaluation, however, was more positive in non-gatekeeping countries. Individual characteristics of doctors and patients explained only a relatively small part of variance. Conclusions: Health care system characteristics do affect GPs' performance in psycho-social care. (aut.ref.)