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GP treatment decisions for patients with depression: an observational study

GP treatment decisions for patients with depression: an observational study. Kendrick T, King F, Albertella L, Smith P Br J Gen Pract 2005;55:280-6. Background. England : Increase in anti-depressant prescriptions- may be inappropriate

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GP treatment decisions for patients with depression: an observational study

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  1. GP treatment decisions for patients with depression: an observational study Kendrick T, King F, Albertella L, Smith P Br J Gen Pract 2005;55:280-6 Journal Club 30/09/05 V Dory

  2. Background • England : Increase in anti-depressant prescriptions- may be inappropriate • Many patients (2/3) with major depression are not receiving recommended treatment • This may be linked to GPs’ beliefs and patients’ beliefs Journal Club 30/09/05 V Dory

  3. Research question :Understanding GP behaviour • What influences GP treatment decisions for depression: • Severity of depression • Patient demographic factors • Adverse life events • Past history • Patient attitudes towards antidepressants (as seen by GPs/ as reported by patients) Journal Club 30/09/05 V Dory

  4. Methods • Observational study • Patients: • HADS (HAD-D  severity) • Socio-demographic factors • Perceived financial difficulties • Brief schedule of threatening life events • Health status • Attitudes to antidepressants Journal Club 30/09/05 V Dory

  5. GPs: • Is patient depressed : 0-4 If >= 2: • Action taken • Adverse life event or difficulties • Patient’s attitude towards antidepressants • Previous mental health problems • Chronic physical health pbs • Previous antidepressant treatment • How well do you know patient • Acknowledgement of diagnosis of depression Journal Club 30/09/05 V Dory

  6. Notes checked after 2 months for subsequent diagnosis of / treatment for depression Journal Club 30/09/05 V Dory

  7. Methods: Recruitment • Recruitment of GP practices Phase I: 2 practices  9 GPs (of 9) Phase II: 6 practices (5 of 7 newly approached + 1 from phase I)  11 GPs (of 18) No information on selection process Journal Club 30/09/05 V Dory

  8. Methods: recruitment • Patients Inclusion criteria: • >18 years old • Able to complete screening questionnaire Exclusion criteria: • Currently taking AD/psychiatric treatment • Terminal illness Journal Club 30/09/05 V Dory

  9. Consent Ph I : directly approached by researcher Ph II: approached by receptionist then researcher Consent slip given to GP before consultation Journal Club 30/09/05 V Dory

  10. Patients • 437 + 257 patients = 694 patients • 59%- 43% of appts • 100 depressed • 67 HAD-D 8-10 • 33 HAD-D >10 Journal Club 30/09/05 V Dory

  11. Results • Missing data • GPs completed questionnaires for 97-95% of patients enrolled • Patients all filled in HAD on the spot but sent other questionnaires by post in 73%-72% of cases (no difference in HAD-D score) Journal Club 30/09/05 V Dory

  12. Results: diagnosis of depression Prév 13,4% Se 33% Sp 89% PPV 31% NPV 89% LR+ 3 LR- 0.75 • GPs are not very accurate: Journal Club 30/09/05 V Dory

  13. Results: treatment decisions • Acknowledgement: 49%/35% • AD: 8%/22% • Follow-up/referral: 16%/7% Journal Club 30/09/05 V Dory

  14. Results: association between AD offers and GP perceptions • Severity of depression Moderate>mild P = 0.019/0.001 • Attitude of patient twds AD P= 0.045/0.004 • Absence of adverse life events or difficulties P=0.03/0.847 Journal Club 30/09/05 V Dory

  15. Results: GP perceptions of patient’s attitudes • GP ‘pos attitude’ // patient ‘addictiveness’ • GP ‘neg attitude’ # patient ‘effectiveness’ Journal Club 30/09/05 V Dory

  16. Results : changes between ph I and II • More offers of AD • No link between offer of AD and adverse life events BUT: Different population Insufficient numbers of GPs Journal Club 30/09/05 V Dory

  17. Discussion : Main findings • Poor diagnostic accuracy • Management : • Lack of acknowledgement with patients • AD offers linked to severity and perceived patient attitude to AD Journal Club 30/09/05 V Dory

  18. Limitations • Selection of practices??? • Relatively small sample size re R/ decisions (101) • 2 phases : different practices so no comparison feasable Journal Club 30/09/05 V Dory

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