Exploring General Practitioners’ Views and Experiences of Providing Care to People with Borderline Personality Disorder in Primary Care: A Qualitative Study in Australia

Julian Wlodarczyk, Sharon Lawn, Kathryn Powell, Gregory B. Crawford, Janne McMahon, Judy Burke, Lyn Woodforde, Martha Kent, Cate Howell and John Litt
Additional contact information
Julian Wlodarczyk: College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia
Sharon Lawn: College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia
Kathryn Powell: Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, Australia
Gregory B. Crawford: North Adelaide Palliative Care Service, Discipline of Medicine, University of Adelaide, Adelaide 5000, Australia
Janne McMahon: Private Mental Health Consumer Carer Network (Australia) Ltd., PO Box 542, Marden 5070, Australia
Judy Burke: Sanctuary BPD Carer Support, Adelaide 5001, Australia
Lyn Woodforde: Carers SA, 338 Tapleys Hill Rd, Seaton 5023, Australia
Martha Kent: Borderline Personality Disorder Centre of Excellence, Country Health SA Mental Health Services, 22 King William St, Adelaide 5000, Australia
Cate Howell: Cate Howell, Cate Howell and Colleagues, 14 Hay St, Goolwa 5214, Australia
John Litt: Department of General Practice, College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia

IJERPH, 2018, vol. 15, issue 12, 1-19

Abstract: The prevalence of people seeking care for Borderline Personality Disorder (BPD) in primary care is four to five times higher than in the general population. Therefore, general practitioners (GPs) are important sources of assessment, diagnosis, treatment, and care for these patients, as well as important providers of early intervention and long-term management for mental health and associated comorbidities. A thematic analysis of two focus groups with 12 GPs in South Australia (in discussion with 10 academic, clinical, and lived experience stakeholders) highlighted many challenges faced by GPs providing care to patients with BPD. Major themes were: (1) Challenges Surrounding Diagnosis of BPD; (2) Comorbidities and Clinical Complexity; (3) Difficulties with Patient Behaviour and the GP–Patient Relationship; and (4) Finding and Navigating Systems for Support. Health service pathways for this high-risk/high-need patient group are dependent on the quality of care that GPs provide, which is dependent on GPs’ capacity to identify and understand BPD. GPs also need to be supported sufficiently in order to develop the skills that are necessary to provide effective care for BPD patients. Systemic barriers and healthcare policy, to the extent that they dictate the organisation of primary care, are prominent structural factors obstructing GPs’ attempts to address multiple comorbidities for patients with BPD. Several strategies are suggested to support GPs supporting patients with BPD.

Keywords: borderline personality disorder; primary care; general practitioners; mental health services; mental illness; qualitative research (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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