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How could depression guidelines be made more relevant and applicable to primary care?

How could depression guidelines be made more relevant and applicable to primary care?
How could depression guidelines be made more relevant and applicable to primary care?
Background
Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice.
Aim
To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context.
Design of study
Review of national guidelines.
Setting
Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore.
Method
Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding.
Results
The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support.
Conclusion
Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.
appraisal, depression, guidelines
0960-1643
e149-e156
Hegarty, Kelsey
04707a09-431a-4cd4-9d19-983b384facac
Gunn, Jane
0be5f1b1-2186-47aa-a84a-b835a47b1f05
Blashki, Grant
6369c124-0136-43bd-9344-024cc590f2c3
Griffiths, Frances
1bb8e612-abbb-4b98-8dc8-83558033d886
Dowell, Tony
64b06335-e010-4510-8740-f453f58d3a63
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Hegarty, Kelsey
04707a09-431a-4cd4-9d19-983b384facac
Gunn, Jane
0be5f1b1-2186-47aa-a84a-b835a47b1f05
Blashki, Grant
6369c124-0136-43bd-9344-024cc590f2c3
Griffiths, Frances
1bb8e612-abbb-4b98-8dc8-83558033d886
Dowell, Tony
64b06335-e010-4510-8740-f453f58d3a63
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Hegarty, Kelsey, Gunn, Jane, Blashki, Grant, Griffiths, Frances, Dowell, Tony and Kendrick, Tony (2009) How could depression guidelines be made more relevant and applicable to primary care? British Journal of General Practice, 59 (562), e149-e156. (doi:10.3399/bjgp09X420581).

Record type: Article

Abstract

Background
Many guidelines have been developed in the area of depression but there has been no systematic assessment of their relevance to general practice.
Aim
To assess national guidelines on general practice management of depression using two complementary approaches to identify specific ways in which guidance could be made more relevant and applicable to the nature of general practice and the patients who seek help in this context.
Design of study
Review of national guidelines.
Setting
Seven English speaking countries: UK, US, Australia, New Zealand, Ireland, Canada, and Singapore.
Method
Seven guidelines were independently reviewed quantitatively using the Appraisal of Guidelines for Research and Evaluation (AGREE) scores and qualitatively using thematic coding.
Results
The quantitative assessment highlights that most of the guidelines fail to meet the criteria on rigour of development, applicability, and editorial independence. The qualitative assessment shows that the majority of guidelines do not address associated risk factors sufficiently and the dilemma of diagnostic uncertainty flows over into management recommendations. Management strategies for depression (antidepressants and psychological strategies) are supported by all of the guidelines, with several listing drugs before psychological therapies; there is limited attention paid to the different types of psychological therapies. Moreover, the guidelines in the main fail to acknowledge individual patient circumstances, in particular the influence on response to treatment of social issues such as adverse life events or social support.
Conclusion
Assessments of current national guidelines on depression management in general practice suggest significant limitations in their relevance to general practice.

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More information

Published date: May 2009
Keywords: appraisal, depression, guidelines

Identifiers

Local EPrints ID: 68823
URI: http://eprints.soton.ac.uk/id/eprint/68823
ISSN: 0960-1643
PURE UUID: 65984b70-473c-44da-b66c-90c948249ac3
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

Catalogue record

Date deposited: 06 Oct 2009
Last modified: 14 Mar 2024 02:42

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Contributors

Author: Kelsey Hegarty
Author: Jane Gunn
Author: Grant Blashki
Author: Frances Griffiths
Author: Tony Dowell
Author: Tony Kendrick ORCID iD

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