Achieving guidelines for the treatment of depression in primary care: is physician education enough?
Med Care
; 35(8): 831-42, 1997 Aug.
Article
en En
| MEDLINE
| ID: mdl-9268255
ABSTRACT
OBJECTIVES:
The authors examine whether physician education has enduring effects on treatment of depression.METHODS:
Depressed primary care patients initiating antidepressant treatment from primary care clinics of a staff-model health maintenance organization were studied. Quasi-experimental and before-and-after comparisons of physician practices, supplemented with patient surveys, were used to compare the process of care and depression outcomes. Intervention consisted of extensive physician education that spanned a 12-month period. This included case-by-case consultations, didactics, academic detailing (eg, clearly stating the educational and behavioral objectives to individual physicians), and role-play of optimal treatment. Main outcome measures were divided into two groups. Quasi-experimental samples included (1) antidepressant medication selection and (2) adequacy (dosage and duration) of pharmacotherapy. Survey samples included (3) intensity of follow-up; (4) physician delivered educational messages regarding depression treatment; (5) patient satisfaction; and (6) depression outcomes.RESULTS:
No lasting educational effect was observed consistently in any of the outcomes measured.CONCLUSIONS:
There was no enduring improvement in the treatment of depression for primary care patients. Depression treatment guidelines were achieved contemporaneously, however, for intervention patients enrolled in a multifaceted program of collaborative care during the training period. These results suggest that continuing programs of reorganized service delivery to support the role of a primary care physician (eg, on-site mental health personnel, close monitoring of patient progress and adherence), in addition to physician training, are essential for the success of guideline implementation.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Médicos de Familia
/
Atención Primaria de Salud
/
Guías de Práctica Clínica como Asunto
/
Trastorno Depresivo
/
Educación Médica Continua
Tipo de estudio:
Clinical_trials
/
Evaluation_studies
/
Guideline
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Aspecto:
Implementation_research
Límite:
Humans
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Med Care
Año:
1997
Tipo del documento:
Article
País de afiliación:
Estados Unidos