Research reportCommunicative skills of general practitioners augment the effectiveness of guideline-based depression treatment
Introduction
Two approaches to improve the effects of depression management in primary care have been studied. The first targets the depression-specific aspects of care stressed in current clinical guidelines. The second addresses nonspecific aspects of care, in particular the communication skills of the GP. Both approaches have been shown to be effective in improving patient outcomes (Rutz et al., 1990, Schulberg et al., 1996, Katon et al., 1996, Roter et al., 1995). Whether these effects are additive or dependent remains unclear, however. Therefore, we examined the main effects of both specific and nonspecific aspects of depression care on outcome as well as their interaction. The core hypothesis in the study was that the effectiveness of the depression-specific interventions depends on the communicative skillfulness of the GP providing the treatment.
Section snippets
Patients and data collection
The present analyses were carried out using data from an intervention study designed to improve process of care for depression and patient outcomes in primary care (Ormel et al., 1998, van Os et al., 1999, van Os et al., 2002, van Os et al., 2004, Tiemens et al., 1999). Eighteen GPs participated in the study. Consecutive patients, aged 18 to 65 years, attending one of the GPs at randomly selected days, were assessed by screening and standardized psychiatric interview. They were asked to fill in
Results
Three-hundred forty-eight patients with an ICD-10 depression were identified at baseline by screening and subsequent diagnostic interview. At the 3-month outcome assessment 86 patients did not participate, 39 had missing data on an outcome measure and 8 on control variables leaving 215 patients (62%) for the analyses. At the 12-month outcome assessment, 63 patients did not participate, 70 had missing data on an outcome measure and 8 on control variables leaving 207 patients (59%). Episode
Findings
We investigated the association between process of care for depression and patient outcomes over 3 and 12 months in a naturalistic design, and examined main effects as well as interactions with the communicative skillfulness of the GP providing the care. On the composite outcome measure, small independent effects on patient outcome were found for recognition and accuracy of diagnosis. A moderate effect on patient outcome was found for treatment with a sedative, which proved to be related to
Acknowledgments
We gratefully acknowledge the participating general practitioners, the research workers who interviewed the patients and H. Hallie for the data entry.
This study was financially supported by the Dutch Organization for Scientific Research (NWO), Medical Sciences, KWAZO-program, from the National Fund for Public Mental Health (NFGV), and SGO, the Promotion Program Health Research.
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