Grief symptoms and primary care use: a prospective study of family caregivers

Abstract

BackgroundFamily caregivers to patients who are severely ill have high use of primary health care and psychotropic medication. However, it remains sparsely investigated whether healthcare services target the most vulnerable caregivers.AimThis study aimed to examine associations between family caregivers’ grief trajectories of persistent high-grief symptom level (high-grief trajectory) versus persistent low-grief symptom level (low-grief trajectory), as well as early contacts with GPs or psychologists and the use of psychotropic medication.Design & settingA population-based cohort study of family caregivers (n = 1735) in Denmark was undertaken.MethodThe Prolonged Grief-13 (PG-13) scale measured family caregivers’ grief symptoms at inclusion (during the patient's terminal illness), 6 months after bereavement, and 3 years after bereavement. Multinomial regression was used to analyse register-based information on GP consultations, psychologist sessions, and psychotropic medication prescriptions in the 6 months before inclusion.ResultsA total of 1447 (83.4%) family caregivers contacted their GP, and 91.6% of participants in the high-grief trajectory had GP contact. Compared with family caregivers in the low-grief trajectory, family caregivers in the high-grief trajectory had ≥4 face-to-face GP consultations (odds ratio [OR] = 2.6; 95% confidence interval [CI] = 1.3 to 5.0), more GP talk therapy (OR =4.4; 95% CI = 1.9 to 10.0), and more psychotropic medication, but not significantly more psychologist sessions (OR = 1.7; 95% CI = 0.5 to 6.6).ConclusionFamily caregivers in the high-grief trajectory had more contact with their GP, but their persisting grief symptoms suggest that primary care interventions for family caregivers should be optimised. Future research is warranted in such interventions and in the referral patterns to specialised mental health care.

Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review

“…39 A variety of methods are needed to ensure that these caregivers receive the support their need. 40 Telehealth services can have the potential to improve health care access and the quality of life for caregivers. Also, telehealth is becoming more accepted by many caregivers and organisations, particularly for people living in rural and remote areas.…”

“…Therefore, in an ageing society with fewer younger caregivers, engaging and supporting this major care group, especially spousal caregivers, is important 39 . A variety of methods are needed to ensure that these caregivers receive the support their need 40 …”

A case of grief: SAPC prize winner

“…Almost all family caregivers contact their GP with regards to grief, and this consultation really made me realise how important an aspect of my practice it will be in the future. 4 It has also made me reflect on the emphasis on undergraduate teaching around 'breaking bad news' to patients, but nothing taught about managing patients in the process of grieving further down the line. 5 The skill required to manage a grieving patient is not one limited to general practice.…”

Abordagem do luto na Atenção Primária em Saúde

“…na Dinamarca identificou, por meio de uma escala que quantifica o luto em diferentes graus de gravidade, os pacientes que sofriam mais com o luto; esses pacientes, quando comparados aos que apresentavam menor impacto do luto em sua qualidade de vida, consultavam mais vezes na Atenção Primária em Saúde (APS) e recebiam mais medicação psicotrópica. 8 Esse dado já havia sido sugerido anteriormente em um estudo de 2016 que identificou o aumento da prescrição de antidepressivos, hipnóticos e ansiolíticos após a perda de um familiar; observou-se também o aumento das consultas em APS no ano subsequente ao óbito. 9 Além disso, o luto complicado está associado a transtorno depressivo maior em 21 a 54% dos pacientes.…”

“…No entanto, muitos profissionais da APS não recebem treinamento adequado para essa abordagem. 8 Este estudo teve como objetivo orientar os profissionais da APS na abordagem ao luto.…”