Primary care psychologists working with general practitioners in an Italian area affected by earthquake and during Covid-19 pandemic: results from 10 years-long experimentation|Psicologi delle cure primarie al fianco dei medici di base in un’area italiana colpita dal terremoto e durante la pandemia di Covid-19: risultati di una sperimentazione durata 10 anni

Psychological suffering represents a part of the global burden of illness of citizens, but the health care system has not yet responded adequately to the burden of mental disorders. At least 50 per cent of the requests brought to General Practitioners (GPs), although expressed as physical symptoms, mostly stem from relational/existential problems, often at a very early stage when intervention would be brief and easily achievable. General practitioners work in a condition to respond adequately to this demand, but end up prescribing clinical investigations and pharmacological treatments of doubtful efficacy. The progressive differentiation between medicine and psychology has made collaboration through referral to a psychologist rather problematic, both in terms of the patients to be referred, and in terms of how to refer them. The primary care psychologist (PCP) can reduce the gap between the need for psychological treatment and its provision. In order to improve access to psychological care, a free, public PCP service has been set up in Abruzzo. Trials in other regions of Italy have provided evidence in favour of a co-located PCP working together with the general practitioner. This study presents evidence from our 10-year trial in the outpatient clinics of general practitioners associated with the ASL1 Sulmona-L’Aquila-Avezzano health district in Abruzzo. The primary outcomes were the user profile and effects of PCP interventions in three different time periods (2014, 2019 and 2022) after the 2009 L’Aquila earthquake and before/after the Covid-19 pandemic. The secondary outcome concerned the effects and functioning of long-term collaboration between PCPs and GPs. Qualitative data were collected through interviews with GPs and outpatients. Thousands of people have accessed the service over the years. The primary outcome showed the great contribution of the PCP intervention on outpatients. The secondary outcome showed that GPs established a functional collaboration with PCPs by visiting patients in co-presence and by referring users to the PCP. The majority of users accessed the PCP service through self-referral, which indicates a strong rooting of the PCP service in the territory. Users’ problems and symptoms disappeared after PCP intervention and drug use was reduced, indicating an effective impact of PCP on citizens and the health system. In general, GPs and outpatients reported interest in and satisfaction with the service. PCP interventions were effective in improving well-being and reducing drug prescriptions and laboratory tests. The results underline the importance of PCP implementation to intercept unexpressed psychological needs.