Does GP training in depression care affect patient outcome? - A systematic review and meta-analysis

Abstract

BackgroundPrimary care practices provide a gate-keeping function in many health care systems. Since depressive disorders are highly prevalent in primary care settings, reliable detection and diagnoses are a first step to enhance depression care for patients. Provider training is a self-evident approach to enhance detection, diagnoses and treatment options and might even lead to improved patient outcomes.MethodsA systematic literature search was conducted reviewing research studies providing training of general practitioners, published from 1999 until May 2011, available on the electronic databases Medline, Web of Science, PsycINFO and the Cochrane Library as well as national guidelines and health technology assessments (HTA).Results108 articles were fully assessed and 11 articles met the inclusion criteria and were included. Training of providers alone (even in a specific interventional method) did not result in improved patient outcomes. The additional implementation of guidelines and the use of more complex interventions in primary care yield a significant reduction in depressive symptomatology. The number of studies examining sole provider training is limited, and studies include different patient samples (new on-set cases vs. chronically depressed patients), which reduce comparability.ConclusionsThis is the first overview of randomized controlled trials introducing GP training for depression care. Provider training by itself does not seem to improve depression care; however, if combined with additional guidelines implementation, results are promising for new-onset depression patient samples. Additional organizational structure changes in form of collaborative care models are more likely to show effects on depression care.

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

“…Sin embargo, no debemos olvidar que dichos planes de gestión incorporan con frecuencia elementos de otros modelos 78,104 , como la a t e n c i ó n e s c a l o n a d a 7 , l a g e s t i ó n d e casos/cuidados 25,49,51,69 o el apoyo a la edu cación y autogestión de los pacientes en el caso del CCM 7,72 . Por otro lado, la comuni cación interprofesional y las actividades de formación y de difusión de las GPC son las intervenciones más frecuentemente imple mentadas, pero también las más cuestiona das cuando se llevan a cabo de manera aisla da 8,22,45,53,68,75,96,107,108 . Nos encontramos, por tanto, con la paradoja de que los mode los más efectivos son los más complejos, lo cual a su vez les hace más difícilmente eva luables, más dependientes de las singulari dades de sus contextos y, por lo tanto, menos transferibles.…”

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

“…Simply offering training to GPs, even if this includes work on skills as well as knowledge, does not lead to improvement in outcomes for patients with mental health problems (apart from, possibly, newly diagnosed depression). 376 Improvement of primary care 'quality' and organisational change are both important. 377 Any initiative needs to be seen as relevant to practices' everyday work, and flexible enough to respond to the challenges posed by the needs of an individual practice.…”

WinWinWin: die wissenschaftliche Perspektive

“…Wissenschaftliche Studien favorisieren heute eindeutig letztere, wobei sie vor allem für affektive Störungen untersucht sind [12][13][14]. Hingegen h aben Fortbildungsprogramme im klassischen Sinn ebenso wie die Einführung von Screenings ohne ein darauf abgestimmtes «Programm» keinen sicheren Effekt auf die Versorgung [12,15]. Unter Collaborative Care wird dabei eine Versorgung verstanden, die folgende Basiskriterien erfüllt: -multidisziplinärer Zugang, meistens Hausarzt und psychosoziale Berufsgruppe; -strukturierter Management-Plan; -sorgfältige Patientennachsorge; -vermehrter interdisziplinärer Austausch.…”