Objective: With the assistance of the WHO a survey was conducted, the OBJECTIVE of which was to identify the level of competence of family physicians in outpatient mental disorders and their motivation and need for conducting the workshops and trainings on major mental disorders encountered in primary care practice.
Methods: A questionnaire was developed and 150 family physicians were interviewed (25 family physicians from each of the 6 FMCs).
Results: While analyzing the obtained data, it has been found that more than 30% of physicians in the FMC have not been using psychotropic medications in their practice, and in the two FMCs only 8-12% of family physicians use psychopharmacological drugs. The survey has demonstrated unequal use of psychotropic medications in the different FMCs. The greater percentage of these medications has been identified in those FMCs, where the working psychiatrist conducts the training seminars on the basics of psychiatry for family physicians. Family physicians, who prescribe psychotropic medications, prefer using the old generation drugs. Thus, the most often mentioned medications were Amitriptylinum (Lat.), Carbamazepine, Diazepam, Phenobarbital, and Clonazepam. In the single instances, the more modern anxiolytics and antidepressants were mentioned such as ISRS and drugs from other groups. As psychotropic medications the dietary supplements and homeopathic medicines were mentioned. With widespread prevalence of anxiety disorders and depressions more than half of family physicians in actual fact do not diagnose them, determining the other diagnoses. Over 45% of respondents mentioned that they “did not know” how to treat patients with such disorders.
Conclusions: The survey results have shown considerable difficulties faced by family physicians in identifying and managing patients with mental disorders. The causes of the problems identified are as the following: insufficient level of family physicians’ competence in using clinical protocols in practice; insufficient provision of district pharmacies with psychotropic medications; restrictions on prescribing psychotropic medications by family physicians; extensive use of old “traditional” treatment patterns; low paying capacity of the population; high degree of stigma with regard to psychotropic medications. As a positive aspect of the survey results, there can be mentioned the willingness of the remarkable part of family physicians (90%) to provide medical assistance to the outpatient forms of mental disorders and gain knowledge and experience in this area. Thus, the survey has enabled the identification of the problems of using psychotropic medications in family practice and the development of measures to address them.