TITLE:
Difficult-to-Treat-Depression—Perceptions of GPs and GP Trainees
AUTHORS:
Kay M. Jones, Leon Piterman, Neil Spike
KEYWORDS:
GP Trainees, Difficult-to-Treat-Depression, General Practice Training, Patient Management
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.4 No.3,
July
21,
2014
ABSTRACT:
Introduction:
GPs are often the first contact point for mental health concerns. Training to
qualify as a GP involves completing a three-to-four year program. Among other
things, the training program may include a six-hour mental health training
workshop. The study’s purpose was to compare GPs’ and Trainees’ perceptions of
difficult-to-treat-depression (DTTD). Methods: Using a semi-structured
interview schedule comprising six questions, 10 GPs and six Trainees participated
in focus groups or telephone interview. To understand participants’
perspectives, data were analyzed using the Framework Method. Findings: Trainees
were less clear than GPs about the meaning of DTTD and other diagnostic terms.
GPs’ diagnosis included querying diagnosis and treatment options. Trainees’
experience was limited but they raised barriers including non-response to various treatment trials. Both groups identified
management difficulties including: doctor shopping, suicide risk,
patients not being well informed; with management difficulties exacerbated by
limited access/referring to health professionals, cost and/or unavailability of
bulk billing. While some GPs and Trainees had heard of an illness management
model or chronic illness model, few used a model. Most reported limited
referring to psychiatrists, mainly because of cost and/or limited availability.
GPs were more likely to refer to other health professionals and use pharmacological
and complementary therapies. Both groups discussed the impact of external
factors including cultural factors, patient compliance, treatment failure, and
the importance of the relationship between the patient and the professional. Trainees
were more likely to stress the importance local clinical guidelines. Discussion
and Conclusion: Despite the small size and limited nature, this research
provides insight into some of the similarities and differences of GPs’ and Trainees’
experiences and understanding of DTTD. This may have implications for training
providers, clinical supervisors and Trainees, and suggests that enhancement in
the role of mental health training may be relevant.