Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care

Anthony, Jean; Baik, Seong-Yi; Bowers, Barbara J.; Tidjani, Bassirou; Jacobson, Christer; Susman, Jeffrey

doi:10.1002/j.2048-7940.2010.tb00286.x

Cited by 47 publications

(46 citation statements)

References 33 publications

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“…49,72,91,97,105,111,118,136,148 Additional studies were conducted in Canada (n = 3 27,107,110 ), Israel (n = 3 130,137,150 ), Italy (n = 3 69,113,127 ), Denmark (n = 2 29,92 ), Spain (n = 2 35,75 ), Finland (n = 1 95 ), Norway (n = 1 151 ), Hong Kong (n = 1 81 ) and UK/China (n = 1 25 ), with one final study where the country of origin was unclear. 101 Of the non-intervention views and predictors studies, the 33 qualitative studies were conducted mostly in the UK (n = 18 177,180,182,192,194,201,204,207,209,210,218,228,229,249,252,253,257,258 ), with additional studies from Australia (n = 5 169,176,221,226,245 ), USA (n = 5 170,183,200,202,208 ), the Netherlands (n = 3 212,…”

Section: Populations and Settingsmentioning

confidence: 99%

“…177,[203][204][205][206][207][208][209][210][211][212][213][214][215] Of these, 12 showed a positive association between increased confidence and better referral outcomes [203][204][205][206][207][208][209][210][211][212][213] (three of these were higher risk of bias 203,205,208 ), and two showed no association between the factors 214,215 (one of which was at higher risk of bias 214 ). Therefore, the evidence for this association was graded as stronger.…”

Section: Confidence In Management Of the Patientmentioning

confidence: 99%

“…The association between strong patient wishes (or the amount of patient pressure imposed on the GP) was reported as being associated with referral outcomes in 24 studies (Table 41), 165,176,177,179,200,202,208,210,217,223,224,237,249,251,[253][254][255][256][257][258][259][260][261]270 of which five were at higher risk of bias. 165,202,208,224,255 Therefore, the evidence for this association was graded as stronger.…”

Section: Patient Pressurementioning

confidence: 99%

“…177,183,207,208,245,251,255,263,264,268,275,285,286,289 Thirteen studies reported that referral was moderated by clinical specialty 177,183,208,245,251,255,263,264,268,275,285,286,289 and only one did not. 207 In this group only one study was at higher risk of bias, 208 and the evidence was graded as stronger. DOI: 10.3310/hsdr03240 HEALTH SERVICES AND DELIVERY RESEARCH 2015 VOL.…”

Section: Patient Factorsmentioning

confidence: 99%

“…24 The presence of comorbidity or the complexity of the presenting condition was further reported as being associated with referral outcomes in 14 studies. Thirteen studies reported that referral was moderated by the complexity of the clinical presentation 166,176,183,208,[264][265][266][267][268]278,281,283,287 and only one did not. 254 This evidence was graded as stronger.…”

Section: Patient Factorsmentioning

confidence: 99%

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What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Blank

Baxter

Woods

et al. 2015

Health Services and Delivery Research

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BackgroundDemand management describes any method used to monitor, direct or regulate patient referrals. Several strategies have been developed to manage the referral of patients to secondary care, with interventions targeting primary care, specialist services, or infrastructure.ObjectiveThis research aimed to conduct an inclusive systematic review and logic model synthesis in order to better understand factors impacting on the effectiveness of interventions targeting referral between primary and secondary medical health care.DesignThe approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes.SettingPrimary health care.Main outcome measuresReferral from primary to secondary care.Review methodsSystematic searches were undertaken to identify recent, relevant studies. Quality of individual studies was appraised, with consideration of overall strength of evidence. A narrative synthesis and logic model summary of the data was completed.ResultsFrom a database of 8327 unique papers, 290 were included in the review. The intervention studies were grouped into four categories of education interventions (n = 50); process change interventions (n = 49); system change interventions (n = 38); and patient-focused interventions (n = 3). Effectiveness was assessed variously in these papers; however, there was a gap regarding the mechanisms whereby these interventions lead to demand management impacts. The findings suggest that, although individual-level interventions may be popular, the stronger evidence relates only to peer-review and feedback interventions. Process change interventions appeared to be more effective when the change resulted in the specialist being provided with more or better quality information about the patient. System changes including the community provision of specialist services by general practitioners, outreach provision by specialists and the return of inappropriate referrals appeared to have evidence of effect. The pathway whereby interventions might lead to service-wide impact was complex, with multiple factors potentially acting as barriers or facilitators to the change process. Factors related, first, to the doctor (including knowledge, attitudes and beliefs, and previous experiences of a service), second, to the patient (including condition and social factors) and, third, to the influence of the doctor–patient relationship. We also identified a number of potentially influential factors at a local level, such as perceived waiting times and the availability of a specialist. These elements are key factors in the pathway between an intervention and intended demand management outcomes influencing both applicability and effectiveness.ConclusionsThe findings highlight the complexity of the referral process and multiple elements that will impact on intervention outcomes and applicability to a local area. Any interventions seeking to change referral practice need to address factors relating to the individual practitioner, the patient and also the situation in which the referral is taking place. These conclusions apply especially to referral management in a UK context where this whole range of factors/issues lies well within the remit of the NHS. This work highlights that intermediate outcomes are important in the referral pathway. It is recommended that researchers include measure of these intermediate outcomes in their evaluation of intervention effectiveness in order to determine where blocks to or facilitators of system-wide impact may be occurring.Study registrationThe study is registered as PROSPERO CRD42013004037.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Populations and Settingsmentioning

confidence: 99%

Section: Confidence In Management Of the Patientmentioning

confidence: 99%

Section: Patient Pressurementioning

confidence: 99%

Section: Patient Factorsmentioning

confidence: 99%

Section: Patient Factorsmentioning

confidence: 99%

See 3 more Smart Citations

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Blank

Baxter

Woods

et al. 2015

Health Services and Delivery Research

View full text Add to dashboard Cite

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Categorical and dimensional perspectives on depression in elderly primary care patients – Results of the AgeMooDe study

Dorow

Stein

Pabst

et al. 2017

Int J Methods Psych Res

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An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.

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Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary‐care research

2011

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Objective: There has been at least 40 years of active research on screening for depression and distress in primary care. Both successes and failures have been documented. The purpose of this focussed narrative review was to summarise this research and present the key lessons for clinicians and researchers working in psychosocial oncology.Methods: We searched for studies assessing the utility of screening in primary care in seven electronic bibliographic databases (CENTRAL, CINAHL, Embase, HMIC, Medline, PsycINFO, Web of Knowledge) from inception to December 2010. Results were reviewed and summarised into key areas.Results: We found that research could be distilled into the following key learning points. Conclusions: Primary care has shown largely what does not work in relation to screening. Namely relying on clinicians' unassisted judgement without infrastructural support, using overcomplex scales with low acceptability, looking for depression alone, using screening without linked treatment, treating in the absence of follow-up and failing to engage patients in their own care. These pitfalls can and should be avoided in psychosocial oncology.

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Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care

Cited by 47 publications

References 33 publications

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis

Categorical and dimensional perspectives on depression in elderly primary care patients – Results of the AgeMooDe study

Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary‐care research

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