Enhancing adherence to prevent depression relapse in primary care

Training Primary Care Physicians to Employ Self-Efficacy-Enhancing Interviewing Techniques: Randomized Controlled Trial of a Standardized Patient Intervention

“…30 Primary care physicians provide the bulk of care for individuals with depression, diabetes, and other chronic illnesses, 37 and research indicates that enhancing self-efficacy can improve health behaviors and outcomes among chronically ill patients. [19][20][21][22][23][24][25][26][27][28][29] Prior studies also indicate that physicians' behaviors during standardized patient encounters correlate with their behaviors during real patient visits. 38,39 In this context, the combined findings of our practicing PCP- Additional studies are warranted to examine whether the effects we observed will generalize to real patients and will lead to improved health behaviors and outcomes.…”

“…The techniques were drawn from self-efficacy theory, other relevant behavioral theories, direct observation of primary care, and research-proven approaches to enhancing self-efficacy and promoting healthy behaviors. [19][20][21][22][23][24][25][26][27][28][29] Figure 1 Study self-efficacy-enhancing interviewing techniques and their presentation sequence.…”

“…19 Theory and research indicate that self-efficacy influences myriad behaviors and can be strengthened by interventions, improving health outcomes. [19][20][21][22][23][24][25][26][27][28][29] We had previously developed a brief intervention for training resident primary care physicians (PCPs) to use self-efficacy-enhancing interviewing techniques (SEE IT). 30 The intervention was grounded in self-efficacy theory, and informed by prior interventions shown to bolster self-efficacy and improve health behaviors and outcomes.…”

Implementation of Guideline-Based Care for Depression in Primary Care

“…Cabana et al, describe multiple barriers that limit PCPs' adherence to guideline-based care that include lack of their awareness, familiarity, and agreement with guidelines, and the inertia of previous practice (Cabana et al, 2002). Yet even if PCPs are knowledgeable and inclined to deliver appropriate depression care, competing patient demands on their time (Rost et al, 2000), low rates of patient adherence with recommended treatment (Lin et al, 2003), and system issues such as a lack of practice support to administer and collect a depression case-finding tool or a reminder system to enhance follow-up care may limit PCPs' ability to produce favorable outcomes. Furthermore, symptom rating scales commonly used to guide treatment in research studies are not routinely used in primary care practice to guide clinical treatment despite their availability.…”

Antidepressant Medication Adherence

“…3,4 Conversely, trust in physician, preference for antidepressant medication, shared decision in treatment choice, and belief in the effectiveness of medication are some factors that have been associated with adherence to medication. 5,6 There is strong evidence that beliefs about antidepressant medication significantly affect self-reported adherence. Fears that the medications are harmful, addicting, or will not help depression have been clearly linked with nonadherence.…”