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Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study

Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study
Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study
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.
0959-8138
b663
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Leydon, Geraldine M.
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
McBride, Anita
2298dd52-643d-4b30-93be-f4319624eca8
Howe, Amanda
01775084-8b2d-48e7-a1a7-966aa5231416
Burgess, Hana
c103e930-9676-49d6-bbab-ca29eb7c4222
Clarke, Pamela
6905ddcf-d519-44bc-8017-2b3f74b54c35
Maisey, Sue
bd5f7d5b-ee3b-423d-9f9c-f470774af2c3
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Dowrick, Christopher
1869ad5e-1959-446c-b2a8-3fcdf3e79667
Leydon, Geraldine M.
c5cdaff5-0fa1-4d38-b575-b97c2892ec40
McBride, Anita
2298dd52-643d-4b30-93be-f4319624eca8
Howe, Amanda
01775084-8b2d-48e7-a1a7-966aa5231416
Burgess, Hana
c103e930-9676-49d6-bbab-ca29eb7c4222
Clarke, Pamela
6905ddcf-d519-44bc-8017-2b3f74b54c35
Maisey, Sue
bd5f7d5b-ee3b-423d-9f9c-f470774af2c3
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5

Dowrick, Christopher, Leydon, Geraldine M., McBride, Anita, Howe, Amanda, Burgess, Hana, Clarke, Pamela, Maisey, Sue and Kendrick, Tony (2009) Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study. BMJ, 338, b663. (doi:10.1136/bmj.b663). (PMID:19299474)

Record type: Article

Abstract

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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More information

Published date: 19 March 2009
Organisations: Community Clinical Sciences

Identifiers

Local EPrints ID: 146255
URI: http://eprints.soton.ac.uk/id/eprint/146255
ISSN: 0959-8138
PURE UUID: b875c256-315d-48ac-8cac-476ad85f55bc
ORCID for Geraldine M. Leydon: ORCID iD orcid.org/0000-0001-5986-3300
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

Catalogue record

Date deposited: 21 Apr 2010 09:16
Last modified: 23 Jul 2022 01:54

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Contributors

Author: Christopher Dowrick
Author: Anita McBride
Author: Amanda Howe
Author: Hana Burgess
Author: Pamela Clarke
Author: Sue Maisey
Author: Tony Kendrick ORCID iD

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