Managing depression in primary care: community survey (original) (raw)
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Depression Treatment in Primary Care
Background: Depression costs the United States $40 billion annually. Primary care physicians play a key role in the identification and treatment of depression. This study focused on the treatment options recommended by physicians and whether physicians were following the recommended treatment guidelines.
Primary Care Physicians' Evaluation and Treatment of Depression
Medical Care Research and Review, 2008
Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with phys...
A Survey of Primary Care Provider Attitudes and Behaviors Regarding Treatment of Adult Depression
The Primary Care Companion to The Journal of Clinical Psychiatry, 2008
To assess primary care provider (PCP) attitudes and self-reported behavior with regard to identifying and managing depression in adult patients before and after a chronic disease/ collaborative care intervention. Method: A self-administered cross-sectional survey was conducted in 6 targeted practices among 39 family practice physicians, family nurse practitioners, and residents before and after implementation of a depression in primary care project. In this project, the sites received tools and training in depression screening and guideline-concordant treatment, facilitated referral services for patients to access mental health providers, psychiatric phone consultation, patient education materials, and services of a depression care manager. The project was conducted from June 2003 through June 2006. Results: Comparison of responses prior to and after the intervention showed that significantly or nearly significantly larger proportions of PCPs endorsed the importance of depression as a patient presenting problem (p = .000), increased provision of supportive counseling (p = .13), more often identified counseling or therapy as effective (p = .07), and more often referred patients to mental health services (p = .001). PCPs also reduced their perception that treating depression is time consuming (p = .000). Conclusions: After a chronic disease/ collaborative care approach to depression treatment in primary care was implemented, PCP attitudes and behaviors about depression treatment were significantly modified. More guideline-concordant care, and increased collaboration with mental health services, was reported. Implications for future primary care depression intervention activities and research are discussed.
Managing depression in primary care
Quality in Health …, 1993
This review is based on Effective Care, Bulletin No 5 Depression is a common problem which ranges from a fluctuation in mood (minor depression or dysthymia) to episodes of major depression involving affective and biological signs. In any year general practitioners (GPs) diagnose an episode of major depression in around 30/O of their patients,' which places a major load on resources in primary care. Only around half of patients with major depression are recognised by GPs. Training" or the use of routine screening instruments' can improve the ability of GPs to detect major depression, and there is evidence that early detection and treatment may reduce the likelihood that the condition will persist. Major depression is an important concept in the recognition and appropriate treatment of patients who present with depressive signs. Episodes of major depression are more common among women than men (ratio of women to men about 2:1),8 and are strongly associated with social circumstances.9 Three main classification systems are currently used in research and clinical practice: Diagnostic and Statistical Maianal of Mental Disorders Third Edition, Revised (DSM-III-R),3 Research Diagnostic Criteria (RDC),'4 and ICD (tenth revision).'' The DSM-IJI-R classification is commonly used in trials and is appropriate for clinical practice; its criteria for major depression are summarised in the box. Depression and suicide There is a clear link between depression and suicide, but in primary care it is not possible to predict accurately which depressed patients
Depression in primary care: difficulties and paradoxes
JPMA. The Journal of the Pakistan Medical Association, 2005
The presentation of depression in primary care is in many ways different from that seen in psychiatric settings. The process of detection and treatment is also different. This is particularly so in developing countries like Pakistan, which has high prevalence rates of depression but poorly organized primary health care services and primary care physicians (PCPs) who have little psychiatric training, either at undergraduate or postgraduate levels. There is a need to review difficulties faced by primary care physicians in detection and management of depression. It is hoped this would lead to better and more effective management of depression at primary health care level.
CMAJ open, 2014
A diagnosis of depression is common in primary care practices, but data are lacking on the prevalence in Canadian practices. We describe the prevalence of the diagnosis among men and women, patient characteristics and drug treatment in patients diagnosed with depression in the primary care setting in Canada. Using electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, we examined whether the prevalence of a depression diagnosis varied by patient characteristics, the number of chronic conditions and the presence of the following chronic conditions: hypertension, diabetes, chronic obstructive pulmonary disease, osteoarthritis, dementia, epilepsy and parkinsonism. We used regression models to examine whether patient characteristics and type of comorbidity were associated with a depression diagnosis. Of the 304 412 patients who had at least 1 encounter with their primary care provider between Jan. 1, 2011, and Dec. 31, 2012, 14% had a diagnosis of d...
The prevelance and recognition of depression in primary care
Indian journal of psychiatry, 1998
In a two stage study of depression, 200 patients attending primary care were randomly investigated. All patients were screened using Beck Depression Inventory (BDI) (Beck & Beamesderfer, 1974) and were interviewed using Clinical Interview for Depression (CID) (Paykel, 1985). Sixty (30%) patients crossed BDI threshold for moderate or severe depression. On CID, forty two (21%) had depression. Being women, divorced or widowed and belonging to unitary families are associated with increased depression. Unemployment and lack of confiding relationship were related to depression The more common manifestations of depression viz. depressed mood, lack of energy and fatigue, decline in work and interest and anorexia had poor discriminatory power for the diagnosis of depression. The depressed patients did not have excess nicotine or alcohol dependence. The treating physicians missed diagnosis of depression in more than two third of patients. Implication of the study for the training of primary c...