Abstract
BACKGROUND: Research into quality of care in primary mental health care has largely focused on the role of the general practitioner (GP) in the detection and management of patients' problems. AIM: To explore depressed patients' perceptions of the quality of care received from GPs. DESIGN OF STUDY: Qualitative study using semi-structured interviews. SETTING: General practices in Greater Manchester. METHOD: Purposive sampling and semi-structured interviewing of 27 patients who had received care from 10 GPs for depression. RESULTS: Quality of care in depression depends on good communication between the doctor and the patient, but patients who are depressed often have difficulty in discussing their problems with doctors. They are also unlikely to be active in seeking care; for example, in making follow-up appointments, especially when they are uncertain that depression is a legitimate reason for seeing the doctor. Patients sometimes accept care that does not meet professional standards, either because of low expectations of what the National Health Service (NHS) can provide, or because of low self-worth associated with their problem. CONCLUSION: The depressed person may feel that they do not deserve to take up the doctor's time, or that it is not possible for doctors to listen to them and understand how they feel. Doctors need to be active in providing care that meets professional standards. We advocate a model of care in which patients with depression are followed up systematically.
Full Text
The Full Text of this article is available as a PDF (77.9 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Andrews G. Should depression be managed as a chronic disease? BMJ. 2001 Feb 17;322(7283):419–421. doi: 10.1136/bmj.322.7283.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Barry C. A., Bradley C. P., Britten N., Stevenson F. A., Barber N. Patients' unvoiced agendas in general practice consultations: qualitative study. BMJ. 2000 May 6;320(7244):1246–1250. doi: 10.1136/bmj.320.7244.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bouhuys A. L., Van den Hoofdakker R. H. A longitudinal study of interaction patterns of a psychiatrist and severely depressed patients based on observed behaviour: an ethological approach of interpersonal theories of depression. J Affect Disord. 1993 Feb;27(2):87–99. doi: 10.1016/0165-0327(93)90081-t. [DOI] [PubMed] [Google Scholar]
- Cromarty I. What do patients think about during their consultations? A qualitative study. Br J Gen Pract. 1996 Sep;46(410):525–528. [PMC free article] [PubMed] [Google Scholar]
- Kadam U. T., Croft P., McLeod J., Hutchinson M. A qualitative study of patients' views on anxiety and depression. Br J Gen Pract. 2001 May;51(466):375–380. [PMC free article] [PubMed] [Google Scholar]
- Katon W., Von Korff M., Lin E., Unützer J., Simon G., Walker E., Ludman E., Bush T. Population-based care of depression: effective disease management strategies to decrease prevalence. Gen Hosp Psychiatry. 1997 May;19(3):169–178. doi: 10.1016/s0163-8343(97)00016-9. [DOI] [PubMed] [Google Scholar]
- Meredith L. S., Orlando M., Humphrey N., Camp P., Sherbourne C. D. Are better ratings of the patient-provider relationship associated with higher quality care for depression? Med Care. 2001 Apr;39(4):349–360. doi: 10.1097/00005650-200104000-00006. [DOI] [PubMed] [Google Scholar]
- Pill R., Prior L., Wood F. Lay attitudes to professional consultations for common mental disorder: a sociological perspective. Br Med Bull. 2001;57:207–219. doi: 10.1093/bmb/57.1.207. [DOI] [PubMed] [Google Scholar]
- Pollock Kristian, Grime Janet. Patients' perceptions of entitlement to time in general practice consultations for depression: qualitative study. BMJ. 2002 Sep 28;325(7366):687–687. [PMC free article] [PubMed] [Google Scholar]
- Priest R. G., Vize C., Roberts A., Roberts M., Tylee A. Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch. BMJ. 1996 Oct 5;313(7061):858–859. doi: 10.1136/bmj.313.7061.858. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Voelker R. Communication gaps hinder full recovery from depression. JAMA. 2001 Mar 21;285(11):1431–1433. [PubMed] [Google Scholar]
- Williams B., Coyle J., Healy D. The meaning of patient satisfaction: an explanation of high reported levels. Soc Sci Med. 1998 Nov;47(9):1351–1359. doi: 10.1016/s0277-9536(98)00213-5. [DOI] [PubMed] [Google Scholar]
- Wyshak G., Barsky A. Satisfaction with and effectiveness of medical care in relation to anxiety and depression. Patient and physician ratings compared. Gen Hosp Psychiatry. 1995 Mar;17(2):108–114. doi: 10.1016/0163-8343(94)00097-w. [DOI] [PubMed] [Google Scholar]