Do GPs' medical records demonstrate a good recognition of depression? A new perspective on case extraction

Joling, Karlijn J.; Marwijk, Harm van; Piek, Ellen; Horst, Henriëtte E. van der; Penninx, Brenda; Verhaak, Peter; Hout, Hein van

doi:10.1016/j.jad.2011.05.001

Cited by 53 publications

(50 citation statements)

References 29 publications

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“…The limited use of clinical codes in the diagnosis of depression is recognised. Rather than a lack of diagnostic accuracy, it probably reflects how clinical coding is not always a part of routine practice and how general practitioners pragmatically prescribe according to symptoms and responses to treatment rather than diagnostic categories 44 45…”

Section: Discussionmentioning

confidence: 99%

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

et al. 2014

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ObjectiveTo evaluate the effects of Quality and Outcomes Framework (QOF) incentivised case finding for depression on diagnosis and treatment in targeted and non-targeted long-term conditions.DesignInterrupted time series analysis.SettingGeneral practices in Leeds, UK.Participants65 (58%) of 112 general practices shared data on 37 229 patients with diabetes and coronary heart disease targeted by case finding incentives, and 101 008 patients with four other long-term conditions not targeted (hypertension, epilepsy, chronic obstructive pulmonary disease and asthma).InterventionIncentivised case finding for depression using two standard screening questions.Main outcome measuresClinical codes indicating new depression-related diagnoses and new prescriptions of antidepressants. We extracted routinely recorded data from February 2002 through April 2012. The number of new diagnoses and prescriptions for those on registers was modelled with a binomial regression, which provided the strength of associations between time periods and their rates.ResultsNew diagnoses of depression increased from 21 to 94/100 000 per month in targeted patients between the periods 2002–2004 and 2007–2011 (OR 2.09; 1.92 to 2.27). The rate increased from 27 to 77/100 000 per month in non-targeted patients (OR 1.53; 1.46 to 1.62). The slopes in prescribing for both groups flattened to zero immediately after QOF was introduced but before incentivised case finding (p<0.01 for both). Antidepressant prescribing in targeted patients returned to the pre-QOF secular upward trend (Wald test for equivalence of slope, z=0.73, p=0.47); the slope was less steep for non-targeted patients (z=−4.14, p<0.01).ConclusionsIncentivised case finding increased new depression-related diagnoses. The establishment of QOF disrupted rising trends in new prescriptions of antidepressants, which resumed following the introduction of incentivised case finding. Prescribing trends are of concern given that they may include people with mild-to-moderate depression unlikely to respond to such treatment.

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Section: Discussionmentioning

confidence: 99%

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

et al. 2014

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“…It was however comparable to that of Wittchen et al (2001), who reported that 59% (ICD-10) to 75% (DSM-IV) of the patients in their study were recognized. The results of a later study on recognition of depression in primary care, Joling et al (2011) indicated that the used definition of recognition influences the percentage of recognition found.…”

Section: Comparison With Literaturementioning

confidence: 99%

“…This method is similar to that of Joling et al (2011), who used different indicators of recognition to construct the most reliable definition (best combination of sensitivity (0.693) and specificity (0.811)) of recognition of depression by GPs.…”

Section: Definition Of Recognition By Gpsmentioning

confidence: 99%

Determinants of (non-)recognition of depression by general practitioners: Results of the Netherlands study of depression and anxiety

Piek

Nolen

Meer

et al. 2012

Journal of Affective Disorders

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Background: Although most depressed patients are treated in primary care, not all are recognized as such. This study explores the determinants of (non-)recognition of depression by general practitioners (GPs), with a focus on specific depression symptoms as possible determinants. Methods: Recognition of depression by GPs was investigated in 484 primary care participants of the Netherlands Study of Depression and Anxiety, with a DSM-IV diagnosis of depression in the past year. Recognition (yes/no) by GPs was based on medical file extractions (GP diagnosis of depressive symptoms/depressive disorder and/or use of antidepressants/referral to mental health care). Potential determinants of (non-)recognition (patient, depression, patient-GP interaction, and GP characteristics) were bivariately tested and variables with a p-value ≤0.2 entered into a multilevel multivariate model. Subgroup analysis was performed on 361 respondents with more reliable GP diagnosis data. Results: 60.5% of patients were recognized by their GP. Patients who did not consult their GP for mental problems, and without comorbid anxiety disorder(s) were less often recognized. In the subgroup, where 68.7% was recognized, in addition to these, decreasing number of symptoms of depression and increased appetite were associated with decreased recognition. No GP characteristics were retained in the final model. Limitations: Some data on recognition were collected retrospectively. Conclusions: In addition to patients without a comorbid anxiety disorder or who did not consult their GP for mental problems, GPs less often recognized patients with fewer depression symptoms or with increased appetite. Recognition may be improved by informing/teaching GPs that also increased appetite can be a symptom of depression.

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“…We retrieved diagnoses from clinical records, which may cause an underestimation of the sensitivity. Those studies in which physicians are asked to purposely make a diagnosis report higher sensitivities (Joling et al, 2011). However, the MINI interview has better psychometric than other screening questionnaires that have been used to assess the detection of mental disorders (Wittchen and Pittrow, 2002;Wittchen et al, 2001).…”

Section: Limitations Of Our Studymentioning

confidence: 99%

Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients

Castro-Rodríguez

Olariu

Garnier-Lacueva

et al. 2015

Journal of Affective Disorders

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Do GPs' medical records demonstrate a good recognition of depression? A new perspective on case extraction

Cited by 53 publications

References 29 publications

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis

Determinants of (non-)recognition of depression by general practitioners: Results of the Netherlands study of depression and anxiety

Diagnostic accuracy and adequacy of treatment of depressive and anxiety disorders: A comparison of primary care and specialized care patients

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