The introduction of the practice nurse mental health in general practices in the Netherlands: effects on number of diagnoses of chronic and acute alcohol abuse

• Published in: BMC family practice Vol. 20; no. 1; pp. 48 - 9
• Main Authors: Abidi, L, Oenema, A, Verhaak, P, Tan, F E S, van de Mheen, D
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-04-2019; BioMed Central; BMC
• Subjects: Alcohol abuse; Alcohol use; Alcoholism; Alcoholism - diagnosis; Care and treatment; Collaborative care; Diagnosis; Drinking (Alcoholic beverages); Electronic health records; Family medicine; General Practice - organization & administration; General practitioners; Health care policy; Health care reform; Health policy; Humans; Linear Models; Management; Medical diagnosis; Medical records; Mental health; Mental Health Services - organization & administration; Multivariate Analysis; Netherlands; Nurse-led care; Nurses; Nursing research; Patients; Practice; Practice nurse mental health; Primary care; Primary care nursing; Primary Health Care - organization & administration; Psychiatric Nursing; Psychologists; Substance abuse treatment; Netherlands; United Kingdom > UK; England; Alcohol abuse; Practice nurse mental health; Nurse-led care; Collaborative care
• ISSN: 1471-2296; 1471-2296
• DOI: 10.1186/s12875-019-0938-3

Since 2008 mental health practice nurses have been gradually introduced in general practices in the Netherlands as part of health policy aiming to improve early identification and treatment of mental health problems in primary care. This study aims to investigate the effect of the introduction of the practice nurse mental health in general practices in the Netherlands on the number of diagnoses of chronic and acute alcohol abuse.
The Netherlands Institute for Health Services Research (NIVEL) retrieved data of a representative sample of general practices (n = 155) for this study. Data were aligned at the starting point of the implementation of the PN-MH to compare the practices on our outcome measures after implementation of the PN-MH. Multilevel regression analyses were conducted to investigate differences in average number of chronic and acute alcohol abuse diagnoses between practices with a practice nurse mental health and control practices (without a practice nurse mental health and without a primary care psychologists).
A significant decrease over time of chronic alcohol abuse diagnoses was observed (ß = -.52, p < 0.05) as well as a significant decrease over time of acute alcohol abuse diagnoses (ß = -.06, p < 0.05). After adjustment for multiple comparisons, no significant differences were found between practices that implemented a practice nurse mental health or only have a primary care psychologist and control practices. Practices that implemented a practice nurse mental health and have a primary care psychologist, had a higher mean of chronic and acute alcohol abuse diagnoses than control practices during all periods, but the differences between these groups were not statistically significant.
Based on the results of this study it seems that the introduction of practice nurses mental health in general practices is not associated with increased diagnoses of chronic or acute alcohol abuse. Potential explanations are barriers experienced by practice nurses to addressing alcohol use with patients and prioritization of other mental health issues over alcohol abuse. In order to improve the management of alcohol abuse by practice nurses, more research is needed on how practice nurses can be involved in diagnosing and treatment of patients with alcohol abuse.