Optimizing the care of patients with depression in primary care: the views of general practitioners

Abstract

Depression is a very common mental illness within the general population and in-patients consulting in general practice. General practitioners are well placed to provide care for patients with mental health problems, as these disorders are often connected with family and social problems, and GPs can provide their patients with long-term follow-up and support. While there are theoretical reasons for the important role of the family doctor, there is limited evidence about how general practitioners view their roles and their capacity to cope with the mental health needs of their patients. This paper explores the experience of 15 general practitioners from Scotland, who were interviewed during the spring of 1998, about how they approached the care of patients with depression in relation to their skills, knowledge and attitudes. The following four key categories of interest are presented which underpin the emergent themes of the study: (1) organizational issues; (2) referral and the use of other professionals; (3) treatment and management issues; (4) stigma. These themes reveal some interesting issues in relation to GPs' recognition and management of depression and it is also clear that the perception of collaboration within primary care and between primary and secondary care is an integral part of the process. The implications of what has been learned from this study may include the development of educational opportunities for GP trainees and established principals, in addition to brief multidisciplinary training opportunities and shared learning events between primary and secondary care.

Qualitative study of depression management in primary care: GP and patient goals, and the value of listening

“…Previous qualitative studies have highlighted patients' self-imposed restraint regarding the length of depression consultations, 6 and the importance of GP intuition 7 and tacit knowledge, 8 in influencing clinical decisions in this area, and GPs' preference for treating depression medically despite acknowledging the difficulty of a 'cure'. 9 Where GPs consider patient preferences when contemplating antidepressants, their assessments of patients' attitudes to treatment may differ from patients' self-reported views.…”

Treading a fine line: is diagnosing depression in young people just medicalising moodiness?

“…This appears to be different from GPs' responses to depression in adults, where organisational issues, referral options, therapies, and stigma influence clinical thinking, but not rejection of depression as a valid conceptual category. 21 In our view this aversion to a diagnosis is related, at least in part, to a perceived lack of therapeutic options. Drug treatment is the last therapeutic option for mild and moderate depression in young people, used only when cognitive behaviourial therapy (CBT) has been implemented without response, and even then only initiated by specialists.…”

General Practitioner Management of Depression

“…Chew-Graham et al (2000) and Chew-Graham et al (2002) found that GPs were eager to give patients a diagnosis of depression to provide some comfort in the absence of effective treatments, and diagnosis was seen to have secondary gain for GP and patient in that a diagnosis of depression allowed the patient time off work and provided a clear consultation outcome for the GP. In contrast, in Railton et al (2000), a diagnosis of depression was considered likely to cause stigma with patients not wanting a psychiatric diagnosis in their medical notes. Anticipated resistance to a diagnosis was reported as a barrier to diagnosis and treatment.…”

“…When discussed, there was a fairly consensual view that guidelines and diagnostic tools did not facilitate diagnosis or treatment for depression. For example, guidelines were seen to categorize depression in unhelpful and not meaningful ways (Railton et al, 2000). Depression was regarded by some GPs as too variable, subjective, or individual to be amenable to guidelines and screening tools (Maxwell, 2005), and these tools were generally considered as unsuitable for use with depressed patients (Lehti et al, 2009;McPherson & Armstrong, 2009):…”

“…(Chew-Graham et al, 2002, p. 635) Limits of training and support. Lack of services seemed to be compounded by the lack of support from other professionals, described as a lack of a shared understanding of roles (Railton et al, 2000), limited support from fellow GPs (Andersson et al, 2002;Andersson et al, 2001), limited support from psychiatric colleagues (Andersson et al, 2002;Andersson et al, 2001), and patients finding a psychiatrist no more useful than their GP (Railton et al, 2000). Psychiatric and medical training were not felt to have been useful (Andersson et al, 2002;Andersson et al, 2001).…”