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Contents of General Practitioner-Patient Consultations in the Treatment of Depression

  • Original Article
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Abstract

BACKGROUND

Counseling of patients is an indispensable part of any drug treatment and even more so in the treatment of depression.

OBJECTIVE

To describe the content of counseling additional to prescribing an antidepressant drug.

SETTING

Sixty-three general practices from all over Germany.

PATIENTS

Three hundred two patients with the diagnosis of either a depressive episode or a recurrent depressive disorder.

MEASUREMENTS

Assessment of the content of the physician-patient encounter by content analysis following the pivotal topic method.

DESIGN

Qualitative study embedded in a drug utilization study on mirtazapine.

RESULTS

In the initial sessions general practitioners focused on building a good therapeutic alliance, assessing the symptoms of illness, explaining the course of treatment, assuring medication compliance, and discussing problems of life. In the middle phase of treatment, physicians also dealt with building a therapeutic alliance, medication compliance, and the progress and course of illness. In the last phase relapse prevention was an important topic. Psychological topics were more important than medication topics. Almost no importance was given to management of side effects, change of cognitions, or suicidal tendencies.

LIMITATIONS

No information is available on how content was actually discussed. Only encounters were observed where an antidepressant was prescribed.

CONCLUSIONS

Counseling plays an important part in day-to-day encounters of general practitioners. Pharmacotherapy is embedded in comprehensive psychological care. Training programs for general practitioners should be specific in respect to different tasks and parts of the physician-patient encounter (e.g., building a therapeutic alliance, support for life problems or change of cognitions).

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References

  1. Cape J, Barker C, Busewicz M, Pistrang N. General praciticioner psychological management of common emotional problems (I): definitions and literature review. Brit J Gen Pract. 2000;50:313–8.

    CAS  Google Scholar 

  2. Bundesärztekammer. Curriculum Psychosomatische Grundversorgung- Basisdiagnostik und Basisversorgung bei Patienten mit psychischen und psychosomatischen Störungen einschließlich Aspekte der Qualitätssicherung, 2. Auflage [Curriculum for basic psychosomatic care-Basic diagnostic and therapeutic care for patients with psychological and psychosomatic disorders including aspects of quality assurance, 2nd edition]. The electronic version of this document can be found online at: http://www.bundesaerztekammer.de/30/Qualitaetssicherung/20Curricula/06CurrPsych/Currpsych.pdf, 2001.

  3. Wittchen HU, Pittrow D. Prevalence, recognition and management of depression in primary care in Germany: The Depression 2000 study. Hum Psychopharmacol Clin Exp. 2002;17:1–11.

    Article  Google Scholar 

  4. Pampallona S, Bollini P, Tibaldi G, Kubelnick B, Munizza C. Combined pharmacotherapy and psychological treatment for depression. A systematic review. Arch Gen Psychiatry. 2004;61:714–9.

    Article  PubMed  Google Scholar 

  5. Sekera E, Archinard M, Stalder H. Depression. Primary care. 2004;4:314–8.

    Google Scholar 

  6. Badger F, Nolan P. Concordance with antidepressant medication in primary care. Nurs Stand. 2006;20:35–40.

    PubMed  Google Scholar 

  7. Peveler R, George C, Kinmonth AL, Campbell M, Thompson C. Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial. BMJ. 1999;319:612–5.

    PubMed  CAS  Google Scholar 

  8. Ramström H, Affandi S, Elofsson K, Petersson S. Differences in beliefs between patients and pharmaceutical specialists regarding medications. Pat Educ Counsel. 2006;62:244–9.

    Article  Google Scholar 

  9. Winefield HR, Murrell TGC, Clifford JV, Farmer EA. The usefulness of distinguishing different types of general practice consultation, or are needed skills always the same? Fam Pract. 1995;12:402–7.

    Article  PubMed  CAS  Google Scholar 

  10. World Health Organisation Diagnostic and management guidelines for mental disorders in primary care: ICD- 10 Chapter V Primary care version. Göttingen: Hogrefe & Huber, 1996.

  11. WHO. International statistical classification of diseases and related health problems (10th revision). Geneva: WHO; 1992.

  12. Linden M, Staats M, Bär T, Zubrägel D. The assessment of treatment strategy in cognitive-behavior- therapy: Using the pivotal topic measure. Psychotherapy Research. 2005;15:382–91.

    Article  Google Scholar 

  13. Mayring P. Qualitative Inhaltsanalyse – Grundlagen und Techniken (4., erweiterte Auflage) [Qualitative content analysis- basics and techniques, 4th edition]. Weinheim: Deutscher Studien Verlag, 1993.

  14. Linden M. Das pharmakotherapeutische Gespräch. Worüber reden Pharmakotherapeuten, oder ist der Pharmakotherapeut sprachlos? Münch Med Wschr. 1986;128:513–5.

    Google Scholar 

  15. Baker R, Reddish S, Robertson N, Hearnshaw A, Jones B. Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice. Brit J Gen Pract. 2001;51:737–41.

    CAS  Google Scholar 

  16. Sharot T, Delgado MR, Phelps EA. How emotion enhances the feeling of remembering. Nature Neurosc. 2004;7:1376–80.

    Article  CAS  Google Scholar 

  17. Dolan RJ. Emotion, cognition, and behavior. Science. 2002;298:1191–4.

    Article  PubMed  CAS  Google Scholar 

  18. Härter M, Bermejo I, Aschenbrenner A, Berger M. Analyse und Bewertung aktueller Leitlinien zur Diagnostik und Behandlung depressiver Störungen [Analysis and evaluation of current guidelines for the diagnosis and treatment of depressive disorders]. Fortschr Neurol Psychiat. 2001;69:390–401.

    Article  PubMed  Google Scholar 

  19. Rost K, Nutting P, Smith J, Werner J, Duan N. Improving depression outcomes in community primary care practice. J Gen Intern Med. 2001;16:143–9.

    Article  PubMed  CAS  Google Scholar 

  20. Lin EHB, Simon GE, Katzelnick DJ, Pearson SD. Does physician education on depression management improve treatment in primary care? J Gen Intern Med. 2001;16:614–9.

    Article  PubMed  CAS  Google Scholar 

  21. Croudace T, Evans J, Harison G, Sharp DJ, Wilkinson E, McCann G, Spence M, Crilly C, Brindle L. Impact of the ICD- 10 Primary Health Care (PHC) diagnostic and management guidelines for mental disorders on detection and outcome in primary care. Brit J Psychiat. 2003;182:20–30.

    Article  PubMed  Google Scholar 

  22. Kroenke K, Taylor-Vaisey A, Dietrich AJ, Oxman TE. Interventions to improve provider diagnosis and treatment of mental disorders in primary care. Psychosomatics. 2000;41:39–52.

    PubMed  CAS  Google Scholar 

  23. Dyche L. Interpersonal skill in medicine: the essential partner of verbal communication. J Gen Intern Med. 2007;22:1035–9.

    Article  PubMed  Google Scholar 

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Acknowledgment

We want to thank all physicians who participated in this study and who reported on the content of their communication with the patients.

The study has been organized and financed by Organon, Germany.

Potential conflict of interest

The data for this study were taken fom a drug surveillance study on mirtazapine that was done by Organon, Germany. Neither the company representatives nor any other party participated in data analysis and writing of the manuscript, nor did they approve or disapprove what has been written.

There is no other conflict of interest.

Author information

Authors and Affiliations

  1. Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin, Teltow/Berlin, Germany

    Michael Linden MD, PhD, Tatjana Christof Dipl-Psych & Christiane Rentzsch Dipl-Psych

Authors
  1. Michael Linden MD, PhD
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  2. Tatjana Christof Dipl-Psych
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  3. Christiane Rentzsch Dipl-Psych
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Corresponding author

Correspondence to Michael Linden MD, PhD.

Additional information

The study has been done in collaboration with Organon Germany, Oberschleissheim, Germany. We thank all general practitioners who participated in the trial.

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Linden, M., Christof, T. & Rentzsch, C. Contents of General Practitioner-Patient Consultations in the Treatment of Depression. J GEN INTERN MED 23, 1567–1570 (2008). https://doi.org/10.1007/s11606-008-0648-3

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  • DOI: https://doi.org/10.1007/s11606-008-0648-3

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