scholarly journals GPs’ views on the use of depression screening and GP-targeted feedback: a qualitative study

2020 ◽  
Author(s):  
Lea-Elena Braunschneider ◽  
Marco Lehmann ◽  
Julia Luise Magaard ◽  
Tharanya Seeralan ◽  
Gabriella Marx ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Communication Channel ◽  
Further Education ◽  
Screening Tools ◽  
Depression Screening ◽  
Short Text ◽  
General Terms ◽  
Detection Of Depression ◽  
Clinical Workload

Abstract Purpose The first aim of this qualitative study was to identify general practitioners’ (GPs’) views on depression screening combined with GP-targeted feedback in primary care. The second aim was to determine the needs and preferences of GPs with respect to GP-targeted feedback to enhance the efficacy of depression screening. Methods A semistructured qualitative interview was conducted with officially registered GPs in Hamburg (Germany). Interviews were audio recorded and transcribed verbatim. An inductive approach was used to code the transcripts. Results Nine GPs (27 to 70 years; 5 male) from Hamburg, Germany, participated. Regarding depression screening combined with GP-targeted feedback, five thematic groups were identified: application of screening; screening and patient–physician relationships; GPs’ attitudes towards screening; benefits and concerns related to screening; and GPs’ needs and preferences regarding feedback. While the negative aspects of screening can be described in rather general terms (e.g., screening determines the mental health competence, screening threatens the doctor–patient relationship, revealing questions harm the patients), its advantages were very specific (e.g., promoting the identification of undetected cases, relief of the daily workload, wider communication channel to reach more patients). Standardized GP-targeted feedback of the screening results was perceived as helpful and purposeful. GPs preferred feedback materials that eased their clinical workload (e.g., short text with visuals, pictures, or images). Conclusion Addressing GPs’ needs is essential when implementing depression screening tools in clinical practice. To overcome prejudices and enhance the efficacy of screening, further education for GPs on the purpose and application on depression screening may be needed. Standardized GP-targeted feedback in combination with depression screening could be the missing link to improve the detection of depression in primary care.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

Use of brief depression screening tools in primary care: consideration of heterogeneity in performance in different patient groups

2004 ◽  
Vol 26 (3) ◽  
pp. 190-198 ◽  
Author(s):  
Verena Henkel ◽  
Roland Mergl ◽  
Ralf Kohnen ◽  
Antje-Kathrin Allgaier ◽  
Hans-Jürgen Möller ◽  
...  
Keyword(s):  
Primary Care ◽  
Screening Tools ◽  
Depression Screening ◽  
Patient Groups

scholarly journals Under detection of depression in primary care settings in low and middle-income countries: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Abebaw Fekadu ◽  
Mekdes Demissie ◽  
Rahel Berhane ◽  
Girmay Medhin ◽  
Teserra Bitew ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Sample Size ◽  
Meta Analysis ◽  
Screening Tools ◽  
Middle Income ◽  
Middle Income Countries ◽  
Primary Care Clinicians ◽  
Detection Of Depression ◽  
Low And Middle Income

ABSTRACTObjectiveDepression is the commonest mental disorder in primary care but is poor identified. The objective of this review was to determine the level of detection of depression by primary care clinicians and its determinants in studies from low-and middle-income countries (LMICs).MethodsDesignSystematic review and meta-analysis. Review protocol was registered in the PROSPERO database (CRD42016039704).DatabasesPubMed, PsycINFO, Medline, EMBASE, LILAC and AJOL.Quality assessmentRisk of bias within studies evaluated with the Effective Public Health Practice Project (EPHPP).Synthesis“Gold standard” diagnosis for the purposes of this review were based on the 9-item Patient Health Questionnaire (PHQ-9; cutoff scores of 5 and 10), structured interview or expert diagnosis. Meta-analysis was conducted excluding studies on special populations. Analysis of pooled data were stratified by diagnostic approaches.ResultsA total of 2223 non-duplicate publications were screened. Ten publications, from two multi-country studies and eight single country studies, making 18 country level reports, were included. One of the multi-country studies used an enriched sample of screen positive participants. Overall methodological quality of the studies was good. Depression detection was 0.0% in five reports and <12% in another five. The pooled detection for two reports that used PHQ-9 at a cutoff point of 5 (combined sample size = 1426) was 3.9% (95% CI = 2.3%, 5.5%); in the four reports that used PHQ-9 cutoff score of 10 (combined sample size =5481), the pooled detection was 7.0% (95% CI = 3.9%, 10.2%). For the enriched sample, the pooled detection was 43.5 % (95% CI: 25.7%, 61.0%). Severity of depression and suicidality were significantly associated with detection.ConclusionsThe extremely low detection of depression by primary care clinicians poses a serious threat to scaling up mental healthcare in LMICs. Interventions to improve detection should be prioritized.Strength and limitation of study▸This is the first review of detection of depression in LMIC settings▸The review was comprehensive in terms of databases searched▸Screening tools were used as gold standards, which may lead to overestimation of prevalence and underestimation of detection▸The small number of studies and the use of different instruments and cutoff▸points precluded exploration of sources of heterogeneity▸The review does not include studies on distress or sub-threshold depression

scholarly journals Patients’ views about screening for atrial fibrillation (AF): a qualitative study in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e033061
Author(s):  
Mark Lown ◽  
Christopher R Wilcox ◽  
Stephanie Hughes ◽  
Miriam Santer ◽  
George Lewith ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Qualitative Study ◽  
Decision Aids ◽  
Care Practice ◽  
Semistructured Interview ◽  
Interview Guide ◽  
Registration Number ◽  
The Cost ◽  
Inductive Thematic Analysis

ObjectivesThere has been increased interest in screening for atrial fibrillation (AF) with commissioned pilot schemes, ongoing large clinical trials and the emergence of inexpensive consumer single-lead ECG devices that can be used to detect AF. This qualitative study aimed to explore patients’ views and understanding of AF and AF screening to determine acceptability and inform future recommendations.SettingA single primary care practice in Hampshire, UK.Participants15 participants (11 female) were interviewed from primary care who had taken part in an AF screening trial. A semistructured interview guide was used flexibly to enable the interviewer to explore any relevant topics raised by the participants. Interviews were recorded, transcribed verbatim and analysed using inductive thematic analysis.ResultsParticipants generally had an incomplete understanding of AF and conflated it with other heart problems or with raised blood pressure. With regards to potential drawbacks from screening, some participants considered anxiety and the cost of implementation, but none acknowledged potential harms associated with screening such as side effects of anticoagulation treatment or the risk of further investigations. The screening was generally well accepted, and participants were generally in favour of engaging with prolonged screening.ConclusionsOur study highlights that there may be poor understanding (of both the nature of AF and potential negatives of screening) among patients who have been screened for AF. Further work is required to determine if resources including decision aids can address this important knowledge gap and improve clinical informed consent for AF screening.Trial registration numberISRCTN 17495003.

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