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Zhang C, Jin X, Luo D, Xu D, Liao J, Gong W. Using virtual patient to assess primary health workers ' competence to detect postpartum depression in Hunan, China. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2021; 46:1129-1137. [PMID: 34911844 PMCID: PMC10930235 DOI: 10.11817/j.issn.1672-7347.2021.210139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary health workers are the first fine to identify postpartum depression, which is important for patients with this disease to get early specialist diagnosis and treatment. The smartphone-based virtual patient is economical, convenient and effective, and has been applied extensively to evaluate the competency to detect postpartum depression, but there is no relevant application in China. This study aims to use virtual patient to assess the current status on the competency of detecting postpartum depression among primary maternal and child health workers in Hunan Province, and to explore potential influencing factors. METHODS A total of 222 primary maternal and child health workers from 3 regions with low, medium, and high economic levels in Hunan Province were enrolled, and smartphone-based virtual patients with postpartum depression were used for the assessment from May to July in 2018, and a self-designed questionnaire was used to investigate their demographic characteristics. The competency to detect postpartum depression was measured by 2 indicators: diagnostic accuracy and treatment accuracy. Descriptive statistical methods were used to describe the competency to detect postpartum depression among them and their demographic characteristics. A logistic regression analysis was used to explore the possible influencing factors for the diagnostic accuracy and treatment accuracy. RESULTS The diagnostic accuracy rate was 64.0%. There was no significant difference between the demographic characteristics and diagnostic accuracy rate (P>0.05). The treatment accuracy rate was 50.9%. The workers from the middle economic level area were more likely to make the correct treatment than those from the low economic level area (OR= 3.229, 95% CI 1.478 to 7.014).Apart from postpartum depression, the 3 most frequently diagnosed items were bipolar disorder (22.1%, 49/222), secondary depression disorder (13.5%, 30/222), and neurasthenia (5.4%, 12/222). Among the correctly diagnosed health workers, the proportion for correct treatment was 29.6% (42/142), and there was no significant difference between the diagnostic accuracy and treatment accuracy (P>0.05). CONCLUSIONS About half of the primary maternal and child health workers in Hunan Province, China have basic competency to detect postpartum depression, but the overall results are not satisfactory. The regional economic level is correlated with the competency of detecting postpartum depression, and the competency of detecting postpartum depression is stronger in more developed areas. Moreover, for the patients who have been identified as postpartum depression, the rate of correct treatment is low, which warrants particular attention in the follow-up training.
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Affiliation(s)
- Chao Zhang
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005.
| | - Xin Jin
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410005.
| | - Dong Xu
- Center for World Health Organization Studies and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou 510080
- Institute for Global Health and Dermatology Hospital, Southern Medical University, Guangzhou 510080
| | - Jing Liao
- Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou 510080
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080
| | - Wenjie Gong
- Department of Maternal, Child and Adolescent Health, Xiangya School of Public Health, Central South University, Changsha 410005.
- Institute of Applied Health Research University of Birmingham, Birmingham B152 TT, UK.
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Reger GM, Norr AM, Gramlich MA, Buchman JM. Virtual Standardized Patients for Mental Health Education. Curr Psychiatry Rep 2021; 23:57. [PMID: 34268633 DOI: 10.1007/s11920-021-01273-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The training of psychiatrists and other mental health professionals requires education on a range of interpersonal, communication, and psychotherapy techniques. Classroom and workshop training must be augmented by experiential learning with feedback for skill implementation with fidelity. Virtual standardized patients (VSPs) are computerized conversational agents that can support experiential learning through standardized, consequence-free training environments at reduced costs. RECENT FINDINGS Research on mental health VSPs is rife with feasibility and acceptability pilot studies across various training populations and settings. Users have generally reported positive reactions to training with VSPs, though frustrations with some VSP speech recognition or VSP response relevance has been reported. Several studies have demonstrated a promising transfer of clinical skills from VSP training to human standardized patients and randomized trials supporting improved skill relative to reading or academic study are encouraging. As technology improves and natural language processing and accurate computer response generation for broad ranging conversational topics emerges, the field would benefit from research on the characteristics of effective VSPs for a range of purposes and trainee populations. Well-designed randomized evaluations of VSPs relative to best practices in education are needed, particularly regarding the impact of VSPs on clinical practice among actual patients.
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Affiliation(s)
- Greg M Reger
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA. .,University of Washington School of Medicine, Seattle, WA, USA.
| | - Aaron M Norr
- University of Washington School of Medicine, Seattle, WA, USA.,VISN 20 Mental Illness Research, Education and Clinical Center, Seattle, WA, USA
| | - Michael A Gramlich
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA
| | - Jennifer M Buchman
- VA Puget Sound Health Care System, 9600 Veterans Drive, A-116, Tacoma, WA, 98493, USA
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Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-1472. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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Wagner BG, Cleland K, Batur P, Wu J, Rothberg MB. Emergency contraception: Links between providers' counseling choices, prescribing behaviors, and sociopolitical context. Soc Sci Med 2019; 242:112588. [DOI: 10.1016/j.socscimed.2019.112588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/20/2019] [Accepted: 10/03/2019] [Indexed: 12/30/2022]
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Mann A, Li A, Radwan K, Karnik NS, Keenan K. Factors Associated with Management of Teen Aggression: Child Psychiatric Clinical Decision Making. J Child Adolesc Psychopharmacol 2017; 27:445-450. [PMID: 26784955 DOI: 10.1089/cap.2015.0059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study explores whether patient-specific and clinician-specific factors are associated with child psychiatrists' use of second generation antipsychotics (SGAs) in the management of aggression in children with attention-deficit/hyperactivity disorder (ADHD). The patient-specific factors included patient's race, caregiver status, and patient engagement in psychotherapy. METHODS Child psychiatrists attending an annual conference (n = 156) were asked to complete an anonymous questionnaire on clinical decision making. Each participant was randomized to one of eight vignettes on a physically aggressive male teenager with methylphenidate-responsive ADHD. Patient race, caregiving status, and patient engagement in psychotherapy were systematically varied. Respondents rated how likely they were to prescribe an SGA and whether they would adjust the patient's current medication. RESULTS Seventy-five percent of participants (n = 117) were uncomfortable with adding an SGA, and 61% (n = 95) were likely to make medication adjustments to the current stimulant. None of the patient-specific factors were related to management recommendations. However, inpatient psychiatrists compared with non-inpatient psychiatrists reported a higher likelihood of using antipsychotics (OR = 2.40, 95% CI [1.181, 4.879], p = 0.016). Midwestern psychiatrists compared with those from other regions also reported a higher likelihood of using antipsychotics (OR = 3.07, 95% CI [1.376, 6.857], p = 0.005). Academic psychiatrists compared with nonacademics were less likely to endorse making adjustments to the current medication regimen (OR = 0.49, 95% CI [0.860, 0.274], p = 0.013). CONCLUSIONS When presented with a hypothetical case, the vast majority of child psychiatrists surveyed advised that additional information was needed before adding an SGA. Many felt the need for more psychosocial information and greater clarity of possible comorbid diagnoses.
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Affiliation(s)
- Andrea Mann
- 1 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
| | - Ang Li
- 2 Department of Statistics, The University of Chicago , Chicago, Illinois
| | - Karam Radwan
- 3 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago , Chicago, Illinois
| | - Niranjan S Karnik
- 4 Department of Psychiatry, Rush University Medical Center , Chicago, Illinois
| | - Kate Keenan
- 3 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago , Chicago, Illinois
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Garland AF, Taylor R, Brookman-Frazee L, Baker-Ericzen M, Haine-Schlagel R, Liu YH, Wong S. Does Patient Race/Ethnicity Influence Physician Decision-Making for Diagnosis and Treatment of Childhood Disruptive Behavior Problems? J Racial Ethn Health Disparities 2014; 2:219-30. [DOI: 10.1007/s40615-014-0069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/26/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022]
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Preferences, Experience, and Attitudes in the Management of Chronic Pain and Depression. Clin J Pain 2014; 30:766-74. [DOI: 10.1097/ajp.0000000000000035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Menear M, Duhoux A, Roberge P, Fournier L. Primary care practice characteristics associated with the quality of care received by patients with depression and comorbid chronic conditions. Gen Hosp Psychiatry 2014; 36:302-9. [PMID: 24629824 DOI: 10.1016/j.genhosppsych.2014.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 01/26/2014] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to identify primary care practice characteristics associated with the quality of depression care in patients with comorbid chronic medical and/or psychiatric conditions. METHOD Using data from cross-sectional organizational and patient surveys conducted within 61 primary care clinics in Quebec, Canada, the relationships between primary care practice characteristics, comorbidity profile, and the recognition and minimally adequate treatment of depression were assessed using multilevel logistic regression analysis with 824 adults with past-year depression and comorbid chronic conditions. RESULTS Likelihood of depression recognition was higher in clinics where accessibility of mental health professionals was not viewed to be a major barrier to depression care [odds ratio (OR)=1.61; 95% confidence interval (CI) 1.13-2.30]. Four practice characteristics were associated with minimal treatment adequacy: greater use of treatment algorithms for depression (OR=1.77; 95% CI=1.18-2.65), high value given to teamwork (OR=2.48; 95% CI=1.40-4.38), having at least one general practitioner at the clinic devote significant time in practice to mental health (OR=1.54; 95% CI=1.07-2.21) and low perceived barriers to depression care due to inadequate payment models (OR=2.12; 95% CI=1.30-3.46). CONCLUSIONS Several primary care practice characteristics significantly influence the quality of care provided to patients with depression and comorbid chronic conditions and should be targeted in quality improvement efforts.
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Affiliation(s)
- Matthew Menear
- Department of Social and Preventive Medicine, University of Montreal; Research Centre of the Centre hospitalier de l'Université de Montréal
| | | | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Sherbrooke University
| | - Louise Fournier
- Department of Social and Preventive Medicine, University of Montreal; Research Centre of the Centre hospitalier de l'Université de Montréal.
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O’Shea RP, Chandler NP, Roy R. Dentists make larger holes in teeth than they need to if the teeth present a visual illusion of size. PLoS One 2013; 8:e77343. [PMID: 24194880 PMCID: PMC3806748 DOI: 10.1371/journal.pone.0077343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 09/02/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Health care depends, in part, on the ability of a practitioner to see signs of disease and to see how to treat it. Visual illusions, therefore, could affect health care. Yet there is very little prospective evidence that illusions can influence treatment. We sought such evidence. METHODS AND RESULTS We simulated treatment using dentistry as a model system. We supplied eight, practicing, specialist dentists, endodontists, with at least 21 isolated teeth each, randomly sampled from a much larger sample of teeth they were likely to encounter. Teeth contained holes and we asked the endodontists to cut cavities in preparation for filling. Each tooth presented a more or less potent version of a visual illusion of size, the Delboeuf illusion, that made the holes appear smaller than they were. Endodontists and the persons measuring the cavities were blind to the parameters of the illusion. We found that the size of cavity endodontists made was linearly related to the potency of the Delboeuf illusion (p<.01) with an effect size (Cohen's d) of 1.41. When the illusion made the holes appear smaller, the endodontists made cavities larger than needed. CONCLUSIONS The visual context in which treatment takes place can influence the treatment. Undesirable effects of visual illusions could be counteracted by a health practitioner's being aware of them and by using measurement.
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Affiliation(s)
- Robert P. O’Shea
- Department of Psychology, University of Otago, Dunedin, New Zealand
- Discipline of Psychology and Cognitive Neuroscience Research Cluster, School of Health and Human Sciences, Southern Cross University, Coffs Harbour, Australia
| | - Nicholas P. Chandler
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Rajneesh Roy
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Dumesnil H, Cortaredona S, Verdoux H, Sebbah R, Paraponaris A, Verger P. General practitioners' choices and their determinants when starting treatment for major depression: a cross sectional, randomized case-vignette survey. PLoS One 2012; 7:e52429. [PMID: 23272243 PMCID: PMC3525552 DOI: 10.1371/journal.pone.0052429] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 11/13/2012] [Indexed: 11/18/2022] Open
Abstract
Background In developed countries, primary care physicians manage most patients with depression. Relatively few studies allow a comprehensive assessment of the decisions these doctors make in these cases and the factors associated with these decisions. We studied how general practitioners (GPs) manage the acute phase of a new episode of non-comorbid major depression (MD) and the factors associated with their decisions. Methodology/Principal Findings In this cross-sectional telephone survey, professional investigators interviewed an existing panel of randomly selected GPs (1249/1431, response rate: 87.3%). We used case-vignettes about new MD episodes in 8 versions differing by patient gender and socioeconomic status (blue/white collar) and disease intensity (mild/severe). GPs were randomized to receive one of these 8 versions. Overall, 82.6% chose pharmacotherapy; among them GPs chose either an antidepressant (79.8%) or an anxiolytic/hypnotic alone (18.5%). They rarely recommended referral for psychotherapy alone, regardless of severity, but 38.2% chose it in combination with pharmacotherapy. Antidepressant prescription was associated with severity of depression (OR = 1.74; 95%CI = 1.33–2.27), patient gender (female, OR = 0.75; 95%CI = 0.58–0.98), GP personal characteristics (e.g. history of antidepressant treatment: OR = 2.31; 95%CI = 1.41–3.81) and GP belief that antidepressants are overprescribed in France (OR = 0.63; 95%CI = 0.48–0.82). The combination of antidepressants and psychotherapy was associated with severity of depression (OR = 1.82; 95%CI = 1.31–2.52), patient's white-collar status (OR = 1.58; 95%CI = 1.14–2.18), and GPs' dissatisfaction with cooperation with mental health specialists (OR = 0.63; 95%CI = 0.45–0.89). These choices were not associated with either GPs' professional characteristics or psychiatrist density in the GP's practice areas. Conclusions/Significance GPs' choices for treating severe MD complied with clinical guidelines better than those for mild MD; GPs rarely recommended psychotherapy alone but rather as a complement to pharmacotherapy. Their decisions were mainly influenced by personal life experience and attitudes regarding treatment more than by professional characteristics. These results call into question the methods and content of continuing medical education in France about MD management.
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Affiliation(s)
- Hélène Dumesnil
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Sébastien Cortaredona
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Hélène Verdoux
- U657, Université Bordeaux, Bordeaux, France
- U657, INSERM, Bordeaux, France
| | - Rémy Sebbah
- Union régionale des professionnels de santé - Médecins libéraux - Provence-Alpes-Côte d'Azur, Marseille, France
| | - Alain Paraponaris
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
| | - Pierre Verger
- UMR912, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Marseille, France
- UMR-S912, Aix Marseille Université, Institut Recherche et Développement (IRD), Marseille, France
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur (ORS Paca), Marseille, France
- * E-mail:
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Hooper LM, Epstein SA, Weinfurt KP, DeCoster J, Qu L, Hannah NJ. Predictors of primary care physicians' self-reported intention to conduct suicide risk assessments. J Behav Health Serv Res 2012; 39:103-15. [PMID: 22218814 PMCID: PMC3586785 DOI: 10.1007/s11414-011-9268-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Primary care physicians play a significant role in depression care, suicide assessment, and suicide prevention. However, little is known about what factors relate to and predict quality of depression care (assessment, diagnosis, and treatment), including suicide assessment. The authors explored the extent to which select patient and physician factors increase the probability of one element of quality of care: namely, intention to conduct suicide assessment. Data were collected from 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying major depression with moderate levels of severity. The authors examined which patient factors and physician factors increase the likelihood of physicians' intention to conduct a suicide assessment. Data from the study revealed that physician-participants inquired about suicide 36% of the time. A random effects logistic model indicated that several factors were predictive of physicians' intention to conduct a suicide assessment: patient's comorbidity status (odds ratio (OR) = 0.61; 95% confidence interval (CI) = 0.37-1.00), physicians' age (OR = 0.67; 95% CI = 0.49-0.92), physicians' race (OR = 1.84; 95% CI = 1.08-3.13), and how depressed the physician perceived the virtual patient to be (OR = 0.58; 95% CI = 0.39-0.87). A substantial number of primary care physicians in this study indicated they would not assess for suicide, even though most physicians perceived the virtual patient to be depressed or very depressed. Further study is needed to establish factors that may be modified and targeted to increase the likelihood of physicians' providing one element of quality of care--suicide assessment--for depressed patients.
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Affiliation(s)
- Lisa M. Hooper
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Box 870231; 315-B Graves Hall, Tuscaloosa, AL 35487, USA. Phone: 1+205-348-5611; Fax: 1+205-348-7584;
| | - Steven A. Epstein
- Department of Psychiatry, Georgetown University Hospital and School of Medicine, 2115Wisconsin Avenue NW, Suite 200, Washington, DC 20007, USA. Phone: 1+202-944-5444;
| | - Kevin P. Weinfurt
- Duke Clinical Research Institute, P.O. Box 17969, Durham, NC, USA. Phone: +1-919-6688019; Fax: +1-919-6687124;
| | - Jamie DeCoster
- University of Virginia, Charlottesville, VA, USA. Phone: +1-205-5340939;
| | - Lixin Qu
- The University of Alabama, Box 870348 Tuscaloosa, AL, USA. Phone: +1-205-3484254; Fax: +1-205-3483526;
| | - Natalie J. Hannah
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, The University of Alabama, Tuscaloosa, AL, USA. Phone: +1-205-3485611; Fax: +1-205-3485487;
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Kosteniuk J, Morgan D, D'Arcy C. Treatment and follow-up of anxiety and depression in clinical-scenario patients: survey of Saskatchewan family physicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:e152-e158. [PMID: 22423029 PMCID: PMC3303668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore family physicians' recommendations for treatment of, and number of weeks to first follow-up visit for, clinical-scenario patients presenting with symptoms of either a major depressive episode (MDE) or generalized anxiety disorder (GAD), as well as physicians' perceived barriers to optimal care for these patients. DESIGN Cross-sectional survey. SETTING Saskatchewan. PARTICIPANTS A total of 331 family physicians practising in Saskatchewan as of December 2007. MAIN OUTCOME MEASURES Type of treatment and number of weeks to first follow-up visit recommended for clinical-scenario patients, as well as family physicians' barriers to providing optimal care. RESULTS The response rate was 49.7% (331 of 666 surveys returned). Most physicians recommended treatment of the GAD-scenario patient (93.7%) and the MDE-scenario patient (90.1%). Most physicians recommended immediate (65.6%) rather than delayed (28.1%) treatment of the GAD-scenario patient, and immediate (55.6%) rather than delayed (34.5%) treatment of the MDE-scenario patient. Pharmacotherapy alone (26.3%) was the most commonly recommended immediate treatment of the GAD-scenario patient; combination pharmacotherapy and counseling (15.8%) was the most commonly recommended immediate treatment of the MDE-scenario patient. Most physicians recommended that the first follow-up visit occur within 2 weeks for the GAD (79.4%) and the MDE (82.5%) clinical-scenario patients. Physicians were more likely to identify themselves rather than patients and the health care system as barriers to providing optimal care to the GAD (39.4%) and the MDE (39.8%) clinical-scenario patients. CONCLUSION Most family physicians recommend immediate treatment and early follow-up for patients presenting with symptoms of GAD or MDE. Physician-related barriers outweigh patient and health system barriers to providing optimal care to patients with common psychiatric disorders.
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Affiliation(s)
- Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, 103 Wiggins Rd, Saskatoon, SK S7N 0W8.
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Abstract
OBJECTIVES I assessed recent trends in mental health disability in the US nonelderly adult population in the context of trends in physical disabilities and psychological distress. METHODS Using data for 312 364 adults aged 18 to 64 years from the US National Health Interview Survey, 1997 to 2009, I examined time trends in self-reported disability attributed to mental health conditions, disability attributed to other chronic problems, and significant psychological distress (measured by using the K6 instrument). RESULTS The prevalence of self-reported mental health disability increased from 2.0% of the nonelderly adult population in the first 3 years (1997 to 1999) to 2.7% in the last 3 years (2007 to 2009), corresponding to an increase of almost 2 million disabled adults. Disability attributed to other chronic conditions decreased and significant psychological distress did not change appreciably. Change in self-reported mental health disability was more pronounced in adults who also reported disability attributed to other chronic conditions or significant psychological distress but who had no mental health contacts in the past year. CONCLUSIONS These findings highlight the need for improved access to mental health services in the community and for better integration of these services with primary care.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Mojtabai R. Does Depression Screening Have an Effect on the Diagnosis and Treatment of Mood Disorders in General Medical Settings? An Instrumental Variable Analysis of the National Ambulatory Medical Care Survey. Med Care Res Rev 2011; 68:462-89. [DOI: 10.1177/1077558710388290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the association of depression screening with the diagnoses of mood disorders and prescription of antidepressants in 73,712 visits to nonpsychiatrist physician offices drawn from the 2005-2007 U.S. National Ambulatory Medical Care Survey. Physicians used depression screening selectively for patients whom they perceived as more likely to have a mood disorder. In bivariate probit analyses with instrumental variables, depression screening did not increase the prevalence of either mood disorder diagnoses or prescription of antidepressants. However, screening was associated with lower rates of antidepressants prescription without a diagnosis of a mood disorder. In visits in which antidepressants were prescribed, 47.4% of the screened visits compared with 16.3% of nonscreened visits had a mood disorder diagnosis. As currently practiced in medical settings, depression screening may help improve targeting and appropriate use of antidepressant medications. Wider use of depression screening may help curb the growing trend of off-label antidepressant prescriptions.
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Affiliation(s)
- Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,
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Scott T, Matsuyama R, Mezuk B. The relationship between treatment settings and diagnostic attributions of depression among African Americans. Gen Hosp Psychiatry 2011; 33:66-74. [PMID: 21353130 PMCID: PMC3073627 DOI: 10.1016/j.genhosppsych.2010.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/02/2010] [Accepted: 12/03/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the relationship between treatment setting characteristics and diagnostic attributions of depression among community-dwelling African Americans. METHODS Data come from the National Survey of American Life, a nationally representative sample of African Americans and Caribbean Blacks. Major Depression (MD) was assessed using the Composite International Diagnostic Inventory. Participants were categorized into four diagnostic groups: never MD, MD never attributed to physical health problems (i.e., affective depression), MD sometimes attributed to physical health problems (i.e., complicated depression), and MD always attributed to physical health problems (i.e., physical depression). Multinomial regression was used for assessment. RESULTS Among 441 participants, 66.4% were classified as affective depression, 17.8% as complicated depression and 15.8% as physical depression. Seeking treatment from a mental health professional was associated with increased likelihood of being in the complicated depression group [adjusted odds ratio (AOR): 5.52; 95% confidence interval (CI): 2.28-13.36]. Seeking treatment from a family doctor was associated with physical depression (AOR: 2.93; 95% CI: 1.18-7.26). Seeking care from three or more different health care providers was associated with complicated depression (AOR: 1.99; 95% CI: 1.17-3.40). CONCLUSION Results suggest that encounters with health care providers influence the diagnostic attribution of depression in a systematic manner.
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Affiliation(s)
- Tamara Scott
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond VA
| | - Robin Matsuyama
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond VA
| | - Briana Mezuk
- Department of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond VA
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Hooper LM, Epstein SA, Qu L, Hannah NJ. Family Medicine and Internal Medicine Physicians’ Attitudes and Beliefs About Depression. J Prim Care Community Health 2010; 2:107-15. [PMID: 23804744 DOI: 10.1177/2150131910387647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians. They examined how physicians’ attitudes (eg, feeling positively or negatively about treating depression in their patients), physicians’ beliefs (eg, beliefs about what their patients think and prefer in terms of depression care), and demographic characteristics (independent variables) predicted optimal depression care (dependent variable). Using logistical regression analyses, they identified differences in treatment decisions between family and internal medicine physicians. Physicians’ specialty and race (family physicians and white physicians were more likely to prescribe a medication) were unique determinants of whether the physician treated depression by prescribing medication; physicians’ specialty and race (family physicians and nonwhite physicians were more likely to provide office-based counseling) were unique determinants of whether the physician treated depression by providing office-based counseling; physicians’ beliefs about depression care and physician age were unique statistically significant determinants of whether the physician treated depression by providing a referral to a mental health specialist. These findings help clarify how physicians’ specialty and beliefs about depression care influence treatment. In addition, the results in this study suggest that there are differences between family and internal medicine physicians in terms of their practice patterns and beliefs in types of treatment that patients would be willing to receive. Implications for future research on primary care depression treatment are discussed.
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Affiliation(s)
| | | | - Lixin Qu
- University of Alabama, Tuscaloosa, AL, USA
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The unmet needs of depressed adolescent patients: how race, gender, and age relate to evidence-based depression care in rural areas. Prim Health Care Res Dev 2010. [DOI: 10.1017/s1463423610000277] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Virtual standardized patients: an interactive method to examine variation in depression care among primary care physicians. Prim Health Care Res Dev 2008; 9:257-268. [PMID: 20463864 DOI: 10.1017/s1463423608000820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND: Some primary care physicians provide less than optimal care for depression (Kessler et al., Journal of the American Medical Association 291, 2581-90, 2004). However, the literature is not unanimous on the best method to use in order to investigate this variation in care. To capture variations in physician behaviour and decision making in primary care settings, 32 interactive CD-ROM vignettes were constructed and tested. AIM AND METHOD: The primary aim of this methods-focused paper was to review the extent to which our study method - an interactive CD-ROM patient vignette methodology - was effective in capturing variation in physician behaviour. Specifically, we examined the following questions: (a) Did the interactive CD-ROM technology work? (b) Did we create believable virtual patients? (c) Did the research protocol enable interviews (data collection) to be completed as planned? (d) To what extent was the targeted study sample size achieved? and (e) Did the study interview protocol generate valid and reliable quantitative data and rich, credible qualitative data? FINDINGS: Among a sample of 404 randomly selected primary care physicians, our voice-activated interactive methodology appeared to be effective. Specifically, our methodology - combining interactive virtual patient vignette technology, experimental design, and expansive open-ended interview protocol - generated valid explanations for variations in primary care physician practice patterns related to depression care.
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