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Senchyna A, Abbiati M, Chambe J, Haller DM, Maisonneuve H. General practitioners' perspectives on barriers to depression care: development and validation of a questionnaire. BMC FAMILY PRACTICE 2020; 21:156. [PMID: 32738899 PMCID: PMC7395981 DOI: 10.1186/s12875-020-01224-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/16/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND General practitioners (GPs) regularly feel challenged by the care of depressed patients and may encounter several barriers in providing best management. GPs' perspectives on barriers to depression care are a subject of growing interest but there is a lack of validated assessment tools. The aim of this study was to develop and validate a questionnaire assessing barriers to depression care (BDC-Q) encountered by GPs in France and the French-speaking part of Switzerland. METHODS The BDC-Q was constructed in five steps: Item development, content validation, pretesting, testing phase and test-retest reliability. The questionnaire items were generated through a literature search. An expert panel of GPs (n = 16) and psychiatrists (n = 3) validated the content and 20 GPs pretested the questionnaire to provide response process validity evidence. We then tested the questionnaire among 116 GPs and used principal component analysis and internal consistency testing (Cronbach's alpha) to structure it into consistent dimensions. Test-retest reliability using Pearson correlation coefficient was assessed with 30 GPs who completed the questionnaire twice after an interval of at least 2 weeks. RESULTS The 25 items BDC-Q was structured in five dimensions: (i) provision of care by the general practitioner, (ii) considering patients' attitudes towards depression, (iii) guidance for care, (iv) collaboration with mental health specialists and (v) access to mental health care. CONCLUSIONS The BDC-Q displays evidence of validity and reliability to meaningfully assess GPs' perspectives on barriers to depression care. It can be used both at a practice level within a quality improvement strategy, and at a broader level, to inform health planners and tailor appropriate strategies to improve depression care in the community.
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Affiliation(s)
- Arun Senchyna
- Primary Care Unit, Faculty of Medicine, University of Geneva, CMU - 1 rue Michel Servet, CH1211, Geneva, Switzerland.
| | - Milena Abbiati
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Juliette Chambe
- General medicine department, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, CMU - 1 rue Michel Servet, CH1211, Geneva, Switzerland
| | - Hubert Maisonneuve
- Primary Care Unit, Faculty of Medicine, University of Geneva, CMU - 1 rue Michel Servet, CH1211, Geneva, Switzerland
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2
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Rivière M, Toullic Y, Lerouge P, Blanchon T, Leroyer A, Plancke L, Prazuck T, Melchior M, Younès N. Management of work-related common mental disorders in general practice: a cross-sectional study. BMC FAMILY PRACTICE 2020; 21:132. [PMID: 32615930 PMCID: PMC7331173 DOI: 10.1186/s12875-020-01203-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND General practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs' management and patterns of referral to other health professionals of patients with work-related CMD and associated factors. METHOD We used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord - Pas-de-Calais region in France (April - August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients' symptoms. Associations between patient, work, GP and contextual characteristics and GPs' management were explored using modified Poisson regression models with robust variance. RESULTS Among the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients' characteristics (occupational and sociodemographic), GPs' characteristics and environmental data were associated with the type of management used by the GP. CONCLUSION Our study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.
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Affiliation(s)
- M Rivière
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012, Paris, France.
- Department of Infectious Diseases, Réseau Sentinelles, Centre Hospitalier Régional, d'Orléans 14 avenue de l'hôpital, 45000, Orléans, France.
| | - Y Toullic
- University department of general practice, Université Lille 2, Lille, France
| | - P Lerouge
- University department of general practice, Université Lille 2, Lille, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012, Paris, France
| | - A Leroyer
- Univ. Lille, CHU Lille, Institut Pasteur de Lille, EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, F-59000, Lille, France
| | - L Plancke
- Regional Federation of Research in Psychiatry and Mental Health Hauts-de-France, Lille, France
| | - T Prazuck
- Department of Infectious Diseases, Réseau Sentinelles, Centre Hospitalier Régional, d'Orléans 14 avenue de l'hôpital, 45000, Orléans, France
| | - M Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, 75012, Paris, France
| | - N Younès
- Université de Versailles Saint-Quentin, Université Paris Saclay, CESP, Team DevPsy, 94807, Villejuif, France
- Centre Hospitalier de Versailles, Hospital Academic Unit of psychiatry for adults, Le Chesnay, France
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3
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Duric P, Harhaji S, O'May F, Boderscova L, Chihai J, Como A, Hranov GL, Mihai A, Sotiri E. General practitioners' views towards diagnosing and treating depression in five southeastern European countries. Early Interv Psychiatry 2019; 13:1155-1164. [PMID: 30277313 PMCID: PMC6445789 DOI: 10.1111/eip.12747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/11/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
AIM To assess and compare general practitioners' (GPs') views of diagnosing and treating depression in five southeastern European countries. METHODS A cross-sectional study was conducted in Albania, Bulgaria, Moldova, Romania, and Serbia. The sample included 467 GPs who completed a hard-copy self-administered questionnaire, consisting of self-assessment questions related to diagnosing and treating depression. RESULTS The most common barriers to managing depression in general practice reported by GPs were: patients' unwillingness to discuss depressive symptoms (92.3%); appointment time too short to take an adequate history (91.9%), barriers for prescribing appropriate treatment (90.6%); and patients' reluctance to be referred to a psychiatrist (89.1%). Most GPs (78.4%) agreed that recognizing depression was their responsibility, 71.7% were confident in diagnosing depression, but less than one-third (29.6%) considered that they should treat it. CONCLUSIONS Improvements to the organization of mental healthcare in all five countries should consider better training for GPs in depression diagnosis and treatment; the availability of mental healthcare specialists at primary care level, with ensured equal and easy access for all patients; and the removal of potential legal barriers for diagnosis and treatment of depression.
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Affiliation(s)
- Predrag Duric
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK.,Institute of Public Health of Vojvodina/Faculty of Medicine, University of Novi Sad, Novi Sad, Vojvodina, Serbia
| | - Sanja Harhaji
- Institute of Public Health of Vojvodina/Faculty of Medicine, University of Novi Sad, Novi Sad, Vojvodina, Serbia
| | - Fiona O'May
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, UK
| | | | - Jana Chihai
- Medical Psychology and Narcology Department, State Medical and Pharmaceutical University Nicolae Testemitanu, Chisinau, Moldova
| | - Ariel Como
- Tirana University Hospital Centre, Tirana, Albania
| | - Georgi L Hranov
- Second Psychiatric Clinic, University Multi-profile Hospital for Active Treatment in Neurology and Psychiatry St. Naum, Sofia, Bulgaria
| | - Adriana Mihai
- Psychiatric Department, University of Medicine and Pharmacy, Targul Mures, Romania
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4
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Intervention psychothérapeutique brève (activation comportementale) pour le traitement de la dépression d’intensité légère à modérée en soins primaires : proposition d’un guide pour la pratique clinique. Presse Med 2019; 48:109-116. [DOI: 10.1016/j.lpm.2018.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/13/2018] [Accepted: 09/26/2018] [Indexed: 11/24/2022] Open
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5
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Aznar-Lou I, Iglesias-González M, Rubio-Valera M, Peñarrubia-Maria MT, Mendive JM, Murrugarra-Centurión AG, Gil-Girbau M, González-Suñer L, Peuters C, Serrano-Blanco A. Diagnostic accuracy and treatment approach to depression in primary care: predictive factors. Fam Pract 2019; 36:3-11. [PMID: 30423158 DOI: 10.1093/fampra/cmy098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The study assessed the predictive factors of diagnostic accuracy and treatment approach (antidepressants versus active monitoring) for depression in primary care. METHODS This is a cross-sectional study that uses information from a naturalistic prospective controlled trial performed in Barcelona (Spain) enrolling newly diagnosed patients with mild to moderate depression by GPs. Treatment approach was based on clinical judgement. Diagnosis was later assessed according to DSM-IV criteria using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview by an external researcher. Patients (sociodemographic, psychiatric diagnosis, severity of depression and anxiety, health-related quality of life, disability, beliefs about medication and illness and comorbidities) and GP factors associated with diagnostic accuracy and treatment approach were assessed using multilevel logistic regression. Variables with missing data were imputed through multiple imputations. RESULTS Two hundred sixty-three patients were recruited by 53 GPs. Mean age was 51 years (SD = 15). Thirty percent met DSM-IV criteria for major depression. Mean depression symptomatology was moderate-severe. Using multivariate analyses, patients' beliefs about medicines were the only variable associated with the antidepressant approach. Specialization in general medicine and being a resident tutor were associated with a more accurate diagnosis. CONCLUSIONS Clinical depression diagnosis by GPs was not always associated with a formal diagnosis through a SCID-I. GPs' training background was central to an adequate depression diagnosis. Patients' beliefs in medication were the only factor associated with treatment approach. More resources should be allocated to improving the diagnosis of depression.
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Affiliation(s)
- Ignacio Aznar-Lou
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain
| | - Maria Iglesias-González
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Rubio-Valera
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - M Teresa Peñarrubia-Maria
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,SAP Delta Llobregat, DAP Costa Ponent, Institut Català de la Salut, Catalonia, Spain
| | - Juan M Mendive
- Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,La Mina Primary Care Centre, Institut Català de la Salut, Sant Adrià de Besós, Spain
| | - Ana G Murrugarra-Centurión
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | - Montserrat Gil-Girbau
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain
| | | | - Carmen Peuters
- Department of Movement and Sports Sciences, Ghent University, Belgium
| | - Antoni Serrano-Blanco
- Teaching, Research and Innovation Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Fundació Idiap Jordi Gol i Gurina, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.,School of Medicine, University of Barcelona, Barcelona, Spain
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6
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Ben Thabet J, Mâalej M, Khemakhem H, Yaich S, Abbes W, Omri S, Zouari L, Zouari N, Dammak J, Charfi N, Maâlej M. The Management of Depressed Patients by the Tunisian General Practitioners: A Critical Trans-sectional Study. Community Ment Health J 2019; 55:137-143. [PMID: 30229347 DOI: 10.1007/s10597-018-0335-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
Under-diagnosed and under-treated, depression has a pejorative prognosis. The general practitioners (GP) represent the most often consulted healthcare professionals by depressed patients. The aim was to describe how the Tunisian GPs manage the depressed patients and to note the difficulties they encounter in order to suggest corrective measures. A survey was conducted among 140 GPs in Sfax Governorate. The percentage of the GPs whose responses conformed to the scientific data in at least 67% of the items was 31.4%. Four factors were correlated to a good management of depression: age (p = 0.028), masculine gender (p = 0.016), long career (p = 0.034) and participation to continuous medical education sessions on depression (p = 0.01). Our study revealed inadequacies in the management of depression by the GPs. GPs were invited to sensitizing meetings. A training on depression was assured for the future internship supervisors by the commission of medicine of family in the Faculty of Medicine of Sfax.
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Affiliation(s)
- Jihène Ben Thabet
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia. .,Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia.
| | - Manel Mâalej
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Hana Khemakhem
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Sourour Yaich
- Department of Preventive Medicine, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Wafa Abbes
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Sana Omri
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Lobna Zouari
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Nasreddine Zouari
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Jamel Dammak
- Department of Preventive Medicine, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Nada Charfi
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Mohamed Maâlej
- Psychiatry C Department, Faculty of Medicine of Sfax, University Hospital Hedi Chaker, Sfax, Tunisia
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7
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Roy M, Dagenais P, Pinsonneault L, Déry V. Better care through an optimized mental health services continuum (Eastern Townships, Québec, Canada): A systematic and multisource literature review. Int J Health Plann Manage 2018; 34:e111-e130. [PMID: 30378709 DOI: 10.1002/hpm.2687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/25/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In 2014, the health authorities of the Eastern Townships (Québec, Canada) commissioned an evaluation of the mental health admission system for adults (GASMA) to identify the best GASMA organizational or structural elements and optimize the mental health services continuum. METHODS To develop better services, seven indicators (ie, accessibility to services, integration of levels of services, user satisfaction, guidance and management time, evaluation tools, professional composition, and interprofessional collaboration) were examined through four evaluation questions. A three-step systematic and multisource evaluation was realized. A systematic review of the scientific and gray literature was performed. This evaluation also included key informant opinions to contextualize results from this review. RESULTS Results from 91 scientific articles, 40 gray literature documents, and 10 interviews highlighted determinants and barriers associated with the examined indicators. From these results, 24 preliminary recommendations were formulated and discussed in a steering committee. These recommendations were then weighted and validated. This served to formulate three final recommendations. CONCLUSION To optimize the regional mental health services continuum, stakeholders should (1) implement a single-window access for adults with mental health needs, (2) develop alternative services based on users' needs, and (3) test the effectiveness of new methods, initiatives, and tools.
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Affiliation(s)
- Mathieu Roy
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pierre Dagenais
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Linda Pinsonneault
- Eastern Townships Public Health Department, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Véronique Déry
- Health Technology and Social Services Assessment Unit, Eastern Townships Integrated University Health and Social Services Centre, Sherbrooke, Québec, Canada.,Department of Community Health Sciences, Faculty of Medicine & Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
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8
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Driot D, Dupouy J. Réponse de l’auteur à propos de la correspondance sur son article : « Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview ». Presse Med 2018; 47:306-308. [DOI: 10.1016/j.lpm.2018.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Norton J, David M, Gandubert C, Bouvier C, Gutierrez LA, Frangeuil A, Macgregor A, Oude Engberink A, Mann A, Capdevielle D. Détection par le médecin généraliste des troubles psychiatriques courants selon l’auto-questionnaire diagnostique le Patient Health Questionnaire : dix ans après, le dispositif du médecin traitant a-t-il modifié la donne ? Encephale 2018; 44:22-31. [DOI: 10.1016/j.encep.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 10/20/2022]
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10
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Dumesnil H, Apostolidis T, Verger P. Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey. PLoS One 2018; 13:e0190565. [PMID: 29385155 PMCID: PMC5791973 DOI: 10.1371/journal.pone.0190565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
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Affiliation(s)
- Hélène Dumesnil
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.,ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | - Pierre Verger
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.,Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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11
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Driot D, Bismuth M, Maurel A, Soulie-Albouy J, Birebent J, Oustric S, Dupouy J. Management of first depression or generalized anxiety disorder episode in adults in primary care: A systematic metareview. Presse Med 2017; 46:1124-1138. [DOI: 10.1016/j.lpm.2017.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 01/09/2023] Open
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12
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Han X, Gibson J, Eggett DL, Parker TL. Bergamot (Citrus bergamia) Essential Oil Inhalation Improves Positive Feelings in the Waiting Room of a Mental Health Treatment Center: A Pilot Study. Phytother Res 2017; 31:812-816. [PMID: 28337799 PMCID: PMC5434918 DOI: 10.1002/ptr.5806] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/19/2017] [Accepted: 02/27/2017] [Indexed: 01/30/2023]
Abstract
Mental health issues have been increasingly recognized as public health problems globally. Their burden is projected to increase over the next several decades. Additional therapies for mental problems are in urgent need worldwide due to the limitations and costs of existing healthcare approaches. Essential oil aromatherapy can provide a cost‐effective and safe treatment for many mental problems. This pilot study observed the effects of bergamot essential oil inhalation on mental health and well‐being, as measured by the Positive and Negative Affect Scale, in a mental‐health treatment center located in Utah, USA. Fifty‐seven eligible participants (50 women, age range: 23–70 years) were included for analysis. Fifteen minutes of bergamot essential oil exposure improved participants' positive feelings compared with the control group (17% higher). Unexpectedly, more participants participated in experimental periods rather than control periods, suggesting even brief exposure to essential oil aroma may make people more willing to enroll in clinical trials. This study provides preliminary evidence of the efficacy and safety of bergamot essential oil inhalation on mental well‐being in a mental health treatment center, suggesting that bergamot essential oil aromatherapy can be an effective adjunct treatment to improve individuals' mental health and well‐being. © 2017 The Authors. Phytotherapy Research published by John Wiley & Sons Ltd.
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Affiliation(s)
- Xuesheng Han
- dōTERRA International, LLC, 389 South 1300 West, Pleasant Grove, UT, 84062, USA
| | - Jacob Gibson
- The Green House Center for Growth and Learning, 135 West Center Street, Pleasant Grove, UT, 84062, USA
| | | | - Tory L Parker
- dōTERRA International, LLC, 389 South 1300 West, Pleasant Grove, UT, 84062, USA
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13
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Mercier A, Benichou J, Auger-Aubin I, Lebeau JP, Houivet E, Van Royen P, Peremans L. How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study. Ann Gen Psychiatry 2015; 14:3. [PMID: 25632295 PMCID: PMC4308843 DOI: 10.1186/s12991-015-0041-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 01/07/2015] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners' (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription. METHODS This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs' age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis. RESULTS The high prescribers were middle-aged (40-59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs' workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population. CONCLUSIONS Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP's practice.
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Affiliation(s)
- Alain Mercier
- />Department of General Practice, Rouen University, CIC Inserm 0204, 1 rue de Germont, 76031 Rouen Cedex, France
- />Department of General Practice, University Paris 13, Sorbonne Paris Cité, Bobigny, France
- />Department of Family practice, Faculty of Medicine, Rouen University, 20 Bd Gambetta, 76000 Rouen, France
| | - Jacques Benichou
- />Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France
| | - Isabelle Auger-Aubin
- />Department of General Practice, Département de médecine générale, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- />EA Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), 75010 Paris, France
| | - Jean-Pierre Lebeau
- />Department of General Practice, Tours University, 10, Boulevard Tonnellé, B.P. 3223, 37032 Tours Cedex 1, France
| | - Estelle Houivet
- />Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France
| | - Paul Van Royen
- />Department of Primary and Interdisciplinary Care, Faculty of Medicine, Health Science University of Antwerp, Antwerp, Belgium
| | - Lieve Peremans
- />Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
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Magalon-Bingenheimer K, Magalon D, Zendjidjian X, Boyer L, Griguer Y, Lançon C. Dépression en médecine générale. Presse Med 2013; 42:419-28. [DOI: 10.1016/j.lpm.2012.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 09/03/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022] Open
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Dupouy J, Bismuth S, Oustric S, Lapeyre-Mestre M. On-site drugs of abuse urinary screening tests for the management of opiate-addicted patients: a survey among French general practitioners. Eur Addict Res 2012; 18:175-83. [PMID: 22440979 DOI: 10.1159/000336540] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 01/10/2012] [Indexed: 11/19/2022]
Abstract
In France, opiate-addicted patients are mainly managed by general practitioners (GPs). Because on-site abuse drugs urinary screening tests (ODUTs) are now on the market, we investigated French GPs' knowledge and practices concerning drug tests with a focus on ODUTs. We conducted a descriptive cross-sectional study in ambulatory practice. Postal questionnaires were sent to a random sample of GPs in the Midi-Pyrénées area of France in December 2009. Of the 482 GPs in the sample, 116 (24.1%) regularly treated opiate- addicted patients. Only 31 of them (26.7%) used drug tests and 4 of them (3.4%) performed ODUTs in their consultation rooms. Most of the GPs did not perform ODUTs because they were unaware of whether such tests were reliable or available. Many French GPs treating opiate-addicted patients regularly did not perform ODUTs and lacked knowledge of them.
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Affiliation(s)
- Julie Dupouy
- University of Toulouse, Department of Family Practice, Faculté de Médecine Rangueil, Toulouse, France.
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16
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Mercier A, Auger-Aubin I, Lebeau JP, Van Royen P, Peremans L. Understanding the prescription of antidepressants: a Qualitative study among French GPs. BMC FAMILY PRACTICE 2011; 12:99. [PMID: 21943348 PMCID: PMC3188468 DOI: 10.1186/1471-2296-12-99] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/24/2011] [Indexed: 11/29/2022]
Abstract
Background One-tenth of France's population is prescribed at least one antidepressant, primarily by General Practitioners. The reasons for this high prescription rate remain unclear. One-third of these prescriptions may not comply with clinical practice guidelines, and 20% are potentially unrelated to any psychiatric condition. Our aim was to explore how GPs declare they use antidepressants in daily practice and understand their reasons for prescribing them. Method Six focus groups including a total of 56 rural and urban GPs, with four interviews were performed. The topic guide focused on reasons for prescribing antidepressants in various primary care situations. Phenomenological analysis was performed by four researchers. Results Antidepressants were seen as useful and not harmful. Personal assessment based on experience and feeling determined the GPs' decisions rather than the use of scales. Twenty-four "non-psychiatric" conditions possibly leading to prescription of antidepressants in primary care were found. Conclusions The GPs reported prescribing antidepressants for a wide range of conditions other than depression. The GPs' decision making process is difficult and complex. They seemed to prefer to focus on their difficulties in diagnosing depression rather than on useless overtreatment. Instead of using the guidelines criteria to detect potential cases of useful prescription, physicians tend to use their own tools based on gut feelings, knowledge of the patient and contextual issues.
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Affiliation(s)
- Alain Mercier
- Department of General Practice, Rouen University and CIC Inserm 0204, Rouen University, Rouen, France.
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