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  • Title: Problems in psychiatric care of 'difficult patients': a Delphi-study.
    Author: Koekkoek B, van Meijel B, Schene A, Hutschemaekers G.
    Journal: Epidemiol Psichiatr Soc; 2009; 18(4):323-30. PubMed ID: 20170047.
    Abstract:
    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.
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