Abstract
BACKGROUND: Take Care is a commercially sponsored educational package for the detection and management of depression by all members of the primary health-care team. AIM: This study was designed to evaluate whether the educational package affects the recognition of psychological illness by general practitioners. METHOD: General practitioners working in 13 practices in North West England or Trent Regional Health Authorities took part the evaluation. Patients who scored more than eight on the depression or anxiety component of the Hospital Anxiety and Depression (HAD) scales, and who were thought by their general practitioner to have a totally physical problem or no illness, were deemed to have a psychological illness that had been 'missed' by the doctor. Changes in the proportion of missed cases before and after exposure to Take Care were estimated. RESULTS: When all practices were considered together, the general practitioners missed a depressive illness in 24.1% of patients before Take Care, and 17.1% afterwards; absolute decrease 7.0% [95% confidence interval (CI) -2.0 to -12.0%]. An improvement was seen in most practices (Wilcoxon matched-pair test P < 0.05). The programme was also associated with a small reduction in the overall proportion of episodes of anxiety missed by the doctor (absolute decrease 4.5%; 95% CI -1.0 to -8.0%) a reduction was found in most practices (Wilcoxon matched-pair test P < 0.05). There was no material difference in the diagnostic false-positive rate of the doctors before and after the introduction of the programme. CONCLUSION: Exposure to an educational package for depression was associated with improved recognition of psychological illness by general practitioners.
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Selected References
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- Paykel E. S., Priest R. G. Recognition and management of depression in general practice: consensus statement. BMJ. 1992 Nov 14;305(6863):1198–1202. doi: 10.1136/bmj.305.6863.1198. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Priest R. G. A new initiative on depression. Br J Gen Pract. 1991 Dec;41(353):487–487. [PMC free article] [PubMed] [Google Scholar]
- Shapiro S., German P. S., Skinner E. A., VonKorff M., Turner R. W., Klein L. E., Teitelbaum M. L., Kramer M., Burke J. D., Jr, Burns B. J. An experiment to change detection and management of mental morbidity in primary care. Med Care. 1987 Apr;25(4):327–339. doi: 10.1097/00005650-198704000-00006. [DOI] [PubMed] [Google Scholar]
- Wilkinson M. J., Barczak P. Psychiatric screening in general practice: comparison of the general health questionnaire and the hospital anxiety depression scale. J R Coll Gen Pract. 1988 Jul;38(312):311–313. [PMC free article] [PubMed] [Google Scholar]
- Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]