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Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study.

ABSTRACT: Little information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency.Patients in the intervention group met their GP regularly at least 4 times during the 3 months intervention. In addition to treatment as usual (TAU), patients completed a self-assessment instrument (Montgomery-Asberg Depression Rating Scale) on each occasion, and then GPs used the completed instrument as the basis for a person-centred discussion of changes in depression symptoms. The control group received TAU. Frequency of visits in the TAU arm was the result of the GPs' and patients' joint assessments of care need in each case. Depression severity was measured with Beck Depression Inventory-II (BDI-II), quality of life with EQ-5D, and psychological well-being with the General Health Questionnaire-12 (GHQ-12). Data on sick leave, antidepressant and sedatives use, and care contacts were collected from electronic patient records. All variables were measured at baseline and 3, 6, and 12 months. Mean intra-individual changes were compared between the intervention and TAU group.There were no significant differences between the intervention and control group in depression severity reduction or remission rate, change in quality of life, psychological well-being, sedative prescriptions, or sick leave during the whole 12-month follow-up. However, significantly more patients in the intervention group continued antidepressants until the 6 month follow-up (86/125 vs 78/133, p?

SUBMITTER: Wikberg C

PROVIDER: S-EPMC5244530 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study.

Wikberg C C Westman J J Petersson E-L EL Larsson M E H ME André M M Eggertsen R R Thorn J J Ågren H H Björkelund C C

BMC family practice 20170119 1

<h4>Background</h4>Little information is available about whether the use of self-assessment instruments in primary care affects depression course and outcome. The purpose was to evaluate whether using a depression self-rating scale in recurrent person-centred GP consultations affected depression severity, quality of life, medication use, and sick leave frequency.<h4>Methods</h4>Patients in the intervention group met their GP regularly at least 4 times during the 3 months intervention. In additio ...[more]

PMID: 28103816

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Project description:Primary care faces challenging times in many countries, mainly caused by an ageing population. The GPs' role to match patients' demand with medical need becomes increasingly complex with the growing multiple conditions population. Shared decision-making (SDM) is recognized as ideal to the treatment decision making process. Understanding GPs' perception on SDM about patient referrals and whether patients' preferences are considered, becomes increasingly important for improving health outcomes and patient satisfaction. This study aims to 1) understand whether countries vary in how GPs perceive SDM, in patients' referral, 2) describe to what extent SDM in GPs' referrals differ between gatekeeping and non-gatekeeping systems, and 3) identify what factors GPs consider when referring to specialists and describing how this differs between gatekeeping and non-gatekeeping systems. Data were collected between October 2011 and December 2013 in 32 countries through the QUALICOPC study (Quality and Costs of Primary Care in Europe). The first question was answered by assessing GPs' perception on who takes the referral decision. For the second question, a multilevel logistic model was applied. For the third question we analysed the GPs' responses on what patient logistics and need arguments they consider in the referral process. We found: 1) variation in GPs reported SDM- 90% to 35%, 2) a negative correlation between gatekeeper systems and SDM-however, some countries strongly deviate and 3) GPs in gatekeeper systems more often consider patient interests, whereas in non-gatekeeping countries the GP's value more own experience with specialists and benchmarking information. Our findings imply that GPs in gatekeeper systems seem to be less inclined to SDM than GPs in a non-gatekeeping system. The relation between gatekeeping/non-gatekeeping and SDM is not straightforward. A more contextualized approach is needed to understand the relation between gatekeeping as a system design feature and its relation with and/or impact on SDM.

Project description:BackgroundAn automated web-based assessment and monitoring system ( www.psynary.com ) has been developed to assist non-specialist clinicians in managing common mood and anxiety disorders. Psynary promotes the use of standardised outcome measures to assess symptom severity and optimise treatments with the aim of improving outcomes and enabling faster recovery. This paper analyses the results from two parallel studies in New Zealand and Japan (OptiMA-1 NZ and Japan) to assess the validity of the R8 Depression scale, one of the system's core outcome measures.MethodsClinical samples were recruited from a public secondary care and a private psychiatry clinic. Participants completed the outcome measures for the study via the online Psynary system. The R8 Depression scale is a 30-item questionnaire which includes all symptom domains covered in the ICD-10 classification of depression. The Patient Health Questionnaire (PHQ-9) was completed at the same time points as the R8 Depression, with a smaller sample also completing a paper-based Quick Inventory of Depressive Symptomatology (QIDS-SR16). Internal validity was quantified via Cronbach's alpha and Guttman lower bounds method. External validation against the PHQ-9 and QIDS used the Pearson's and Kendall's correlation coefficients. Severity categories were set using a multivariate regression model.Results270 patients participated in the study and completed a maximum of 1 baseline and 5 reviews within a 90-day period, giving a total of 1124 assessments with the PHQ-9 also being completed in 1053 of these assessments. R8 Depression normative data was also collected from 204 non-clinical volunteers with 187 of these also completing the PHQ9. Internal reliability scores were all higher than 0.9 (n = 1328). There was overall good external validity when comparing the R8 Depression to the PHQ-9, with a correlation of 0.91 for the combined normative and clinical samples (n = 1240).ConclusionsThe R8 Depression has been developed as a patient-rated outcome measure for depression for administration on an online system called "Psynary". It has high internal and external validity against current widely used scales. Further work is underway to determine the sensitivity to change of the R8 Depression.

Project description:The transformation toward more sustainable food choices may be supported by an education for sustainable nutrition. In schools, biology teachers play a key role in educating students as sustainability change makers, as biology lessons provide various opportunities to deal with ESD-topics such as sustainable nutrition. Teachers' classroom practices may be influenced by their personal choices regarding sustainable nutrition. Additionally, students may see their teachers as role models for sustainable behavior. This presents the risk of students adopting teachers' beliefs and behaviors without reflection. Teaching sustainable nutrition is therefore in potential conflict with indoctrinating young people toward sustainable diets. To date, no studies have addressed the perceived risk of indoctrination in the context of teaching sustainable nutrition in relation to teachers' personal beliefs, behaviors, and teaching practices. Therefore, this study explored whether biology teachers themselves perceive a risk of indoctrination when teaching sustainable nutrition, and what methods they use for teaching it in a non-indoctrinating way. For this purpose, we conducted semi-structured interviews with seven in-service biology teachers from high schools in Germany. Data for this explorative qualitative study were collected from July to October 2021 using convenience sampling. These were analyzed by qualitative coding and content analysis. The preliminary results of this study show that participants recognize a high risk of indoctrination when teaching sustainable nutrition, primarily due to their own teaching actions, such as deciding whether to reveal their own dietary choices to students. While some participants believed teachers must be restrained, others thought that open communication about personal choices could benefit student decision-making skills. In terms of avoiding indoctrination when teaching sustainable nutrition, participants advocated for student-centered and multi-perspective teaching approaches. Based on the findings, initial implications for further research and teacher training are discussed.

Dataset Information

Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study.

Publications

Use of a self-rating scale to monitor depression severity in recurrent GP consultations in primary care - does it really make a difference? A randomised controlled study.

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