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

Journal title PSICOLOGIA DELLA SALUTE
Author/s Enrico Perilli, Angela Paris, Matteo Perazzini, Danilo Bontempo, Simona Marcotullio, Federica Carubbi, Barbara Catania, Marialuisa D’Agostino, Sara Citerei, Cecilia Cappuccini, Olimpia Paris, Laura Paolucci, Martina Bucci, Stefano Cobianchi
Publishing Year 2025 Issue 2025/2
Language English Pages 17 P. 128-144 File size 133 KB
DOI 10.3280/PDS2025-002008
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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.

Keywords: public health, general pratictioners, primary care psychologist, mental health.

  1. Bray, J. H. (2004). Training primary care psychologists. Journal of Clinical Psychology in Medical Settings, 11(2): 101-107. DOI: 10.1023/B:JOCS.0000025721.17763.D7
  2. AIFA (2022). The Medicines Utilisation Monitoring Centre. National Report on Medicines use in Italy. Year 2021. Rome: Italian Medicines Agency, 2022. https://www.aifa.gov.it/-/l-uso-dei-farmaci-in-italia-rapporto-osmed-2021 (Last access on 16/01/2023).
  3. Andrews, G., Henderson, S. and Hall, W. (2001). Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. The British journal of psychiatry: the journal of mental science, 178: 145-153.
  4. Apostoleris, N. H. (2000). Integrating psychological services into primary care in an underserved community: Examining the referral process for onsite mental health services. Presented at the Northeast Regional Conference of the Society of Teachers of Family Medicine, Philadelphia.
  5. ARESS, Regione Piemonte (2013). Indirizzi e raccomandazioni per l’implementazione dell’assistenza psicologica nelle cure primarie nella rete sanitaria territoriale del Piemonte. http://www.ipap-jung.eu/wp-content/uploads/2018/05/Linee-guida-regionali_psic-e-cure-primarie.pdf (Last access on 15/12/2022)
  6. Barsky, A. J., Orav, E. J. and Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of general psychiatry, 62(8): 903-910. DOI: 10.1001/ARCHPSYC.62.8.903
  7. Blount, A. (2003). Integrated Primary Care: Organizing the Evidence. Families, Systems, & Health, 21(2): 121-133. DOI: 10.1037/1091-7527.21.2.12
  8. Brettle, A., Hill, A., Jenkins, P. (2008) Counselling in primary care: a systematic review of the evidence. Counselling and Psychotherapy Research, 8(4): 207-214. DOI: 10.1080/14733140802453794
  9. Casini, F., Sighinolfi, C., Tedesco, P., Bandieri, P. V., Bologna, M., Colombini, N., Curcetti, C., Magnani, M., Morini, M., Serio, A., Tarricone, I., Berardi, D. and Menchetti, M. (2013). Primary care physicians’ perspective on the management of anxiety and depressive disorders: a cross-sectional survey in Emilia Romagna Region. BMC family practice, 14: 75. DOI: 10.1186/1471-2296-14-75
  10. Chomienne, M. H., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P. and Farmanova-Haynes, E. (2011). Family doctors and psychologists working together: doctors’ and patients’ perspectives. Journal of evaluation in clinical practice, 17(2): 282–287. DOI: 10.1111/J.1365-2753.2010.01437.X
  11. Cordella, B. (2014). Medicina Generale e Psicologia: studio delle resocontazioni relative alla sperimentazione italiana. Rassegna di Psicologia, 1: 57-76. https://www.rivisteweb.it/doi/10.7379/76448
  12. Cubic, B., Mance, J., Turgesen, J. N. and Lamanna, J. D. (2012). Interprofessional education: preparing psychologists for success in integrated primary care. Journal of clinical psychology in medical settings, 19(1): 84–92. DOI: 10.1007/S10880-011-9291-Y
  13. Curcetti, C., Morini, M., and Parisini, L. (2014). Programma regionale “giuseppe leggieri”. Integrazione tra cure primarie e salute mentale. https://www.yumpu.com/s/g10yiJpWQW4gvQLj
  14. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science (New York, N.Y.), 196(4286): 129–136. DOI: 10.1126/SCIENCE.847460
  15. Gatchel, R. J. (2004). Comorbidity of Chronic Pain and Mental Health Disorders: The Biopsychosocial Perspective. American Psychologist, 59(8): 795-805. DOI: 10.1037/0003-066X.59.8.795
  16. Goodrich, D. E., Kilbourne, A. M., Nord, K. M. and Bauer, M. S. (2013). Mental health collaborative care and its role in primary care settings. Current psychiatry reports, 15(8): 383. DOI: 10.1007/S11920-013-0383-2
  17. Katon, W., Lin, E., von Korff, M., Russo, J., Lipscomb, P. and Bush, T. (1991). Somatization: A spectrum of severity. The American Journal of Psychiatry, 148(1): 34-40. DOI: 10.1176/AJP.148.1.3
  18. Lazzari, D. (2019). La psiche tra salute e malattia. Evidenze ed epidemiologia. Milano: Edizioni Edra.
  19. Lussetti, M., De Lilla, R., Madrucci, M., Taranto, L., Paradisi, G., Scotto, R. and Cardamone, G. (2012). Il trattamento dei Disturbi Mentali Comuni (DMC): una nuova rivoluzione. Nuova rassegna di studi psichiatrici, vol. 6. https://www.nuovarassegnastudipsichiatrici.it/numeri-precedenti/vol-6-20-dicembre-2012 (Last access on 15/01/2023)
  20. Martin, A., Rauh, E., Fichter, M. and Rief, W. (2007). A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial. Psychosomatics, 48(4): 294–303. DOI: 10.1176/APPI.PSY.48.4.294
  21. McDaniel, S. H., Belar, C. D., Schroeder, C., Hargrove, D. S. and Freeman, E. L. (2002). A training curriculum for professional psychologists in primary care. Professional Psychology: Research and Practice, 33(1): 65-72. DOI: 10.1037/0735-7028.33.1.65
  22. Osservatorio sulla Salute Psicologica Umbria (2019). Gli umbri e lo psicologo, fruizioni e considerazioni. I dati della ricerca, La mente che cura. Rivista dell’Ordine degli Psicologi dell’Umbria, V, 6: 10-14. https://www.ordinepsicologiumbria.it/wp-content/uploads/2017/06/numero-6-2019-low.pdf
  23. Perilli, E., Perazzini, M., Bontempo, D., Ranieri, F., Di Giacomo, D., Crosti, C., Marcotullio, S. and Cobianchi, S. (2022). Reduced Anxiety Associated to Adaptive and Mindful Coping Strategies in General Practitioners Compared with Hospital Nurses in Response to COVID-19 Pandemic Primary Care Reorganization. Frontiers in psychology, 13: 891470.
  24. Santoro, P., Canale, N., Laugelli, E., Michieletto, N., Vieno, A., Simonelli, A., Santinello, M. (2016). Lo psicologo di base: primi risultati dalla sperimentazione in Veneto in “psicologia della salute”. Conference: VIII congresso nazionale della sezione di psicologia clinica e dinamica At, Roma https://www.researchgate.net/publication/308293238_primary_care_psychology_in_veneto_region_preliminary_results
  25. Smith, G. R., Rost, K. and Kashner, T. M. (1995). A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry, 52(3): 238–243. DOI: 10.1001/ARCHPSYC.1995.03950150070012
  26. Solano, L., Di Trani, M., Ferri, R., Renzi A. (2015). Offrire risposte dove emerge la domanda: lo psicologo di base nell’assistenza sanitaria primaria. Ricerche di psicologia, 1: 237-254.
  27. Solano, L., Ferri, R., Magnani, M., Renzi, A. and Di Trani M. (2020). L’esperienza di collaborazione tra psicologi della salute e medici di medicina generale (MMG) della Scuola di Psicologia della Salute di Roma. Psicologia della Salute, 1: 79-91. DOI: 10.3280/PDS2020-001007
  28. Solano, L. (2011). Dal Sintomo alla Persona. Medico e Psicologo insieme per l’assistenza di base. Milano: FrancoAngeli.
  29. Verhaak, P. F., Kamsma, H. and van der Niet, A. (2013). Mental health treatment provided by primary care psychologists in The Netherlands. Psychiatric services (Washington, D.C.), 64(1): 94–97. DOI: 10.1176/APPI.PS.201100541
  30. Report 2014, Regione Emilia-Romagna, Bologna. https://salute.regione.emilia-romagna.it/normativa-e-documentazione/rapporti/archivio/programma-regionale-giuseppe-leggieri-integrazione-tra-cure-primarie-e-salute-mentale (Last access on 10/12/2022)

Enrico Perilli, Angela Paris, Matteo Perazzini, Danilo Bontempo, Simona Marcotullio, Federica Carubbi, Barbara Catania, Marialuisa D’Agostino, Sara Citerei, Cecilia Cappuccini, Olimpia Paris, Laura Paolucci, Martina Bucci, Stefano Cobianchi, 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 in "PSICOLOGIA DELLA SALUTE" 2/2025, pp 128-144, DOI: 10.3280/PDS2025-002008