Managing depression in primary care

Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

doi:10.11622/smedj.2017080

Cited by 28 publications

(37 citation statements)

References 36 publications

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“…However, over 30% of patients with depressive symptoms do not receive treatment [7,29,30]. Reasons patients do not pursue treatment include cost and side effects of antidepressant medications, fear of perceived risk of addiction and dependence, and stigma associated with a mental health treatment [31,32]. In this population of adults receiving primary care, each additional mg/dL of serum magnesium was associated with about one quarter fewer points on the PHQ-2 depression scale after adjusting for age, gender, race, diabetes, kidney disease, and the time between measurement of serum magnesium and PHQ-2.…”

Section: Discussionmentioning

confidence: 99%

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population

et al. 2019

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Depression is common, places a large burden on the patient, their family and community, and is often difficult to treat. Magnesium supplementation is associated with improved depressive symptoms, but because the mechanism is unknown, it is unclear whether serum magnesium levels act as a biological predictor of the treatment outcome. Therefore, we sought to describe the relationship between serum magnesium and the Patient Health Questionnaire (PHQ, a measure of depression) scores. A cross-sectional analysis of medical records from 3604 adults (mean age 62 years; 42% men) seen in primary care clinics between 2015 and 2018, with at least one completed PHQ were included. The relationship between serum magnesium and depression using univariate analyses showed a significant effect when measured by the PHQ-2 (−0.19 points/mg/dL; 95% CI −0.31, −0.07; P = 0.001) and the PHQ-9 (−0.93 points/mg/dL; 95% CI −1.81, −0.06; P = 0.037). This relationship was strengthened after adjusting for covariates (age, gender, race, time between serum magnesium and PHQ tests, and presence of diabetes and chronic kidney disease) (PHQ-2: −0.25 points/mg/dL; 95% CI −3.33, −0.09; P < 0.001 and PHQ-9: −1.09 95% CI −1.96 −0.21; P = 0.015). For adults seen in primary care, lower serum magnesium levels are associated with depressive symptoms, supporting the use of supplemental magnesium as therapy. Serum magnesium may help identify the biological mechanism of depressive symptoms and identify patients likely to respond to magnesium supplementation.

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Section: Discussionmentioning

confidence: 99%

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population

et al. 2019

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“…Two important tasks of a primary care provider in the first consultation with a new patient are to identify a health condition, by case finding or screening, and diagnose that health condition [ 10 , 23 , 32 - 34 ]. The key aspect to these tasks is information gathering.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, these systems can check whether the consultations with other health care providers have been occurring and if they have been successful. For diabetes, this may relate to visits to the endocrinologist, ophthalmologist, nephrologist, among others [ 35 , 36 ]; for depression, this may relate to visits to the psychotherapist and psychiatrist [ 32 , 37 , 39 ]. Additionally, the systems may check with the patients whether there have been laboratory or other tests performed, and the primary care office could check with those external sites if the results have not made it back to the primary care level.…”

Section: Resultsmentioning

confidence: 99%

Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review

et al. 2020

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Background Digital medical interview assistant (DMIA) systems, also known as computer-assisted history taking (CAHT) systems, have the potential to improve the quality of care and the medical consultation by exploring more patient-related aspects without time constraints and, therefore, acquiring more and better-quality information prior to the face-to-face consultation. The consultation in primary care is the broadest in terms of the amount of topics to be covered and, at the same time, the shortest in terms of time spent with the patient. Objective Our aim is to explore how DMIA systems may be used specifically in the context of primary care, to improve the consultations for diabetes and depression, as exemplars of chronic conditions. Methods A narrative review was conducted focusing on (1) the characteristics of the primary care consultation in general, and for diabetes and depression specifically, and (2) the impact of DMIA and CAHT systems on the medical consultation. Through thematic analysis, we identified the characteristics of the primary care consultation that a DMIA system would be able to improve. Based on the identified primary care consultation tasks and the potential benefits of DMIA systems, we developed a sample questionnaire for diabetes and depression to illustrate how such a system may work. Results A DMIA system, prior to the first consultation, could aid in the essential primary care tasks of case finding and screening, diagnosing, and, if needed, timely referral to specialists or urgent care. Similarly, for follow-up consultations, this system could aid with the control and monitoring of these conditions, help check for additional health issues, and update the primary care provider about visits to other providers or further testing. Successfully implementing a DMIA system for these tasks would improve the quality of the data obtained, which means earlier diagnosis and treatment. Such a system would improve the use of face-to-face consultation time, thereby streamlining the interaction and allowing the focus to be the patient's needs, which ultimately would lead to better health outcomes and patient satisfaction. However, for such a system to be successfully incorporated, there are important considerations to be taken into account, such as the language to be used and the challenges for implementing eHealth innovations in primary care and health care in general. Conclusions Given the benefits explored here, we foresee that DMIA systems could have an important impact in the primary care consultation for diabetes and depression and, potentially, for other chronic conditions. Earlier case finding and a more accurate diagnosis, due to more and better-quality data, paired with improved monitoring of disease progress should improve the quality of care and keep the management of chronic conditions at the primary care level. A somewhat simple, easily scalable technology could go a long way to improve the health of the millions of people affected with chronic conditions, especially if working in conjunction with already-established health technologies such as electronic medical records and clinical decision support systems.

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“…Such an approach appears to be one of the most popular among Latvian family physicians. However, there are recommendations stating that patients should be referred to a psychiatrist only under conditions of comorbid medical conditions, no improvement after one or two trials of medication, substance abuse, psychotic symptoms, risk of suicide or pregnancy (Ng et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Latvian Family Physicians’ Experience and Attitude in Diagnosing and Managing Depression

Vinogradova

Vrubļevska

Rancāns

2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Depression is among the most common mental disorders in primary care. Despite high prevalence rates it remains to be under-diagnosed in primary care settings over the world. This study was aimed to identify Latvian family physicians’ (FPs) experience and attitude in diagnosing and managing depression. It was carried out within the framework of the National Research Programme BIOMEDICINE 2014–2017. After educational seminars on diagnosing and managing depression, FPs were asked to complete a structured questionnaire. In total 216 respondents were recruited. Most of the doctors, or 72.2% (n = 156), agreed with the statement that patients with depression use primary care facilities more often than other patients. More than a half of physicians, or 66.3% (n = 143) quite often asked their patients about their psycho-emotional status and 65.7% (n = 142) of clinicians thought that they can successfully assess a patient’s psychoemotional status and possible mental disorders. The majority, or 91.6 % (n = 198), supposed that routine screening for depression is necessary in Latvia. Despite the fact that a significant number, or 62.6% (n = 135) of FPs thought that their practice was well suitable for the treatment of depressive patients, half of the respondents, or 50.9% (n = 110), assessed their ability to build a trustful contact and to motivate patients for treatment as moderate. Although FPs acknowledged the importance and necessity to treat depression, current knowledge and management approaches were far from optimal. This justifies the need to provide specific training programmes for FPs.

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Managing depression in primary care

Cited by 28 publications

References 36 publications

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population

The Association between Serum Magnesium Levels and Depression in an Adult Primary Care Population

Improving the Primary Care Consultation for Diabetes and Depression Through Digital Medical Interview Assistant Systems: Narrative Review

Latvian Family Physicians’ Experience and Attitude in Diagnosing and Managing Depression

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