Dowrick, Christopher, Leydon, Geraldine M., McBride, Anita, Howe, Amanda, Burgess, Hana, Clarke, Pamela, Maisey, Sue and Kendrick, Tony
Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study
BMJ, 338, . (doi:10.1136/bmj.b663). (PMID:19299474).
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Objective: to gain understanding of general practitioners’ and patients’ opinions of the routine introduction of standardised measures of severity of depression through the UK general practice quality and outcomes framework.
Design Semistructured qualitative interview study, with purposive sampling and constant comparative analysis.
Participants: 34 general practitioners and 24 patients.
Setting: 38 general practices in three sites in England: Southampton, Liverpool, and Norfolk.
Results: patients generally favoured the measures of severity for depression, whereas general practitioners were generally cautious about the validity and utility of such measures and sceptical about the motives behind their introduction. Both general practitioners and patients considered that assessments of severity should be seen as one aspect of holistic care. General practitioners considered their practical wisdom and clinical judgment ("phronesis") to be more important than objective assessments and were concerned that the assessments reduced the human element of the consultation. Patients were more positive about the questionnaires, seeing them as an efficient and structured supplement to medical judgment and as evidence that general practitioners were taking their problems seriously through a full assessment. General practitioners and patients were aware of the potential for manipulation of indicators: for economic reasons for doctors and for patients to avoid stigma or achieve desired outcomes.
Conclusions: despite general practitioners’ caution about measures of severity for depression, these may benefit primary care consultations by increasing patients’ confidence that general practitioners are correct in their diagnosis and are making systematic efforts to assess and manage their mental health problems. Further education of primary care staff may optimise the use and interpretation of depression questionnaires.
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