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Counsellors in Primary Care

Surfers among you will have seen Bandolier's medical links (for which many thanks to Andrew Booth at SCHAAR) - pages where more information can be garnered.

Some of these are terrific. Barry Marshall's Helicobacter Foundation has up-to-the minute information on Helicobacter pylori diagnosis and treatment, the Journal Club on the Web keeps thoughtful reader on their toes, and JAMA allow surfers to search through recent issues of about 10 journals - mostly with abstracts.

The NHS R&D programme has also put up many pages of pertinent information. One of the best is the Development and Evaluation Committee report series edited by Andrew Stevens, and maintained in the S&W.

Counsellors in primary care

This article by Glenn Roberts opens up new horizons with a useful broad brush overview in an area with only one RCT.

To pick out some points from the article:-

  • 31% of practices were using counsellors in 1993.
  • The task of counsellors is to "give the client an opportunity to explore, discover and clarify ways of living more resourcefully and towards greater well-being".
  • Counsellors most often work with people with depression, anxiety or panic attacks, with other mental health problems, or with relationship problems. There is scope for them to work with other people with diseases like diabetes, asthma and coronary heart disease.
  • It has been suggested that a minimum of 30 hours of counselling per week per 10,000 population would realise cost savings - though it is unlikely that a single counsellor would meet a full range of needs.
  • There is evidence of benefit from counselling, but perhaps the key sentence is that the "presence of a counsellor seems to be greatly appreciated by patients and their doctors", mirroring some thoughts in the editorial . There is some evidence that inadequate counselling can be a problem.
  • Decreased surgery attendance, use of psychotropic drugs and reductions in referrals may result in savings to practices.

This report doesn't have all the answers. For any practice considering the use of counsellors, or wishing to ensure the maximum benefit from their use, this report is a good place to start.

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