A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK

Maxwell, M., Harris, F., Hibberd, C., Donaghy, E., Pratt, R., Williams, C. , Morrison, J. , Gibb, J., Watson, P. and Burton, C. (2013) A qualitative study of primary care professionals’ views of case finding for depression in patients with diabetes or coronary heart disease in the UK. BMC Family Practice, 14(46), (doi:10.1186/1471-2296-14-46)

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Abstract

<p>Background Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.</p> <p>Methods Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.</p> <p>Results We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.</p> <p>Conclusion The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.</p>

Item Type:Articles
Keywords:Depression; Case finding; Screening; PHQ9; Diabetes; Coronary heart disease; Primary care
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Williams, Professor Christopher and Morrison, Professor Jillian
Authors: Maxwell, M., Harris, F., Hibberd, C., Donaghy, E., Pratt, R., Williams, C., Morrison, J., Gibb, J., Watson, P., and Burton, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
Journal Name:BMC Family Practice
Publisher:BioMed Central
ISSN:1471-2296
ISSN (Online):1471-2296
Copyright Holders:Copyright © 2013 The Authors
First Published:Reproduced in BMC Family Practice 14(46)
Publisher Policy:Reproduced under a Creative Commons License

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