Roles and practices of general practitioners and psychiatrists in management of depression in the community.Reportar como inadecuado

Roles and practices of general practitioners and psychiatrists in management of depression in the community. - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

1 SPMC - Santé Publique et maladies Chroniques : Qualité de vie Concepts, Usages et Limites, Déterminants 2 Département d-évaluation médicale 3 Département de pharmacologie 4 Lundbeck-France 5 Troubles du comportement alimentaire de l-adolescent 6 Direction de la Politique médicale

Abstract : BACKGROUND: Little is known about depressed patients- profiles and how they are managed. The aim of the study is to compare GPs and psychiatrists for 1 degrees sociodemographic and clinical profile of their patients considered as depressed 2 degrees patterns of care provision. METHODS: The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder. RESULTS: Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban 10.5% v 5.4% - OR = 2.4, educated 42.4% v 25.4% - OR = 3.9, met DSM-IV criteria for depression 94.6% v 85.6% - OR = 2.9, had been hospitalized for depression 26.1% v 15.6% - OR = 2.0 and were younger at onset of depressive problems all adjusted p < .001. No difference was found for psychiatric and somatic comorbidity, suicide attempt and severity of current depression. Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants 7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8 with longer duration of antidepressant treatment. GPs- patients received more -non-conventional- treatment 8.8% v 2.4% OR = 0.3 and less psychotherapy 72.2% v 89.1% OR = 3.1 all adjusted p < .001. CONCLUSION: Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.

Autor: Sophie Tardieu - Alain Bottero Patrick Blin - Michael Bohbot - Sylvia Goni - Alain Gerard Isabelle Gasquet -



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