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Problems in psychiatric care of ‘difficult patients’: a Delphi-study*

Published online by Cambridge University Press:  11 April 2011

Bauke Koekkoek ,
Berno Van Meijel ,
Aart Schene  and
Giel Hutschemaekers
Bauke Koekkoek*
Affiliation:
Altrecht Mental Health Care, Department of Outpatient Community Care, Zeist (The Netherlands) Gelderse Roos Mental Health Care, Institute for Professionalization, Wolfheze (The Netherlands)
Berno Van Meijel
Affiliation:
INHolland University for Applied Sciences, Research Group Mental Health Nursing. Amsterdam (The Netherlands)
Aart Schene
Affiliation:
Academic Medical Center of the University of Amsterdam, Department of Psychiatry Amsterdam (The Netherlands)
Giel Hutschemaekers
Affiliation:
Institute for Professionalizzation, Gelderse Roos Mental Health Care, Wolfheze (The Netherlands) Radboud, Academic Centre of Social Sciences, Nijmegen (The Netherlands)
*
Address fo correspondence: Mr. B. Koekkoek, Oude Arnhemseweg 260 3705 BK Zeist (The Netherlands). Fax: +31-306965466 E-mail: b.koekkoek@altrecht.nl
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Summary

Aims – ‘difficult patients’ may evoke strong feelings in health professionals. The ambivalent attitude of, especially, non-psychotic chronic patients towards psychiatric care may be frustrating and burdensome to professionals. Many of these patients are cared for in non-specialized services, where professionals are often more used to working with psychotic patients. Specific problems with ‘difficult’ non-psychotic patients may occur, and hamper the quality of care offered. The aim of this research is to determine precisely what problems psychiatric professionals perceive in contact with non-psychotic chronic patients in order to identify starting points for alternative or improved care in non-specialized services. Methods – a modified five-phase Delphi study with three groups of eight participants from was used to identify and prioritize experts' judgments. Results – 46 problems were identified of which some were relevant to one or two subgroups and some were relevant to the entire group. Conclusions – a program that combines a coherent view at services level, with support and increased communication at the interprofessional level (e.g. through regular supervision, sharing of case-loads) may be highly beneficial to non-specialized services.

Declaration of Interest: None for any author. Funding for this study was provided by ZonMW ‘Geestkracht’ (Grant 100–002–031), Altrecht Mental Health Care and Gelderse Roos Mental Health Care.

Keywords

community mental health teamsprofessional-patient relationssocial psychiatrylong-term careDelphi
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 4 , December 2009 , pp. 323 - 330
Copyright
Copyright © Cambridge University Press 2010

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Footnotes

*

Contributions: BK designed the study, recruited participants, col-lected and analysed data and drafted the manuscript. BvM designed the study, collected and analysed data and co-drafted the manuscript. AS and GH designed the study, analysed data an co-drafted the manuscript.

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