Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study

BACKGROUND: The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. METHODS: focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding. RESULTS: The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made CONCLUSION: Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice

Barriers in recognising, diagnosing and managing depressive and anxiety disorders as experienced by Family Physicians; a focus group study

BACKGROUND The recognition and treatment of depressive- and anxiety disorders is not always in line with current standards. The results of programs to improve the quality of care, are not encouraging. Perhaps these programs do not match with the problems experienced in family practice. This study aims to systematically explore how FPs perceive recognition, diagnosis and management of depressive and anxiety disorders. METHODS focus group discussions with FPs, qualitative analysis of transcriptions using thematic coding. RESULTS The FPs considered recognising, diagnosing and managing depressive- and anxiety disorders as an important task. They expressed serious doubts about the validity and usefulness of the DSM IV concept of depressive and anxiety disorders in family practice especially because of the high frequency of swift natural recovery. An important barrier was that many patients have difficulties in accepting the diagnosis and treatment with antidepressant drugs. FPs lacked guidance in the assessment of patients' burden. The FPs experienced they had too little time for patient education and counseling. The under capacity of specialised mental health care and its minimal collaboration with FPs were experienced as problematic. Valuable suggestions for solving the problems encountered were made CONCLUSION Next to serious doubts regarding the diagnostic concept of depressive- and anxiety disorders a number of factors were identified which serve as barriers for suitablemental health care by FPs. These doubts and barriers should be taken into account in future research and in the design of interventions to improve mental health care in family practice.This study was co-funded by the International Health Foundation, Utrecht, the Netherlands

Home-based initiatives for acute management of COVID-19 patients needing oxygen: differences across The Netherlands

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an ‘early hospital discharge’ program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff’s qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care

The Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in Dutch advanced cancer patients

Item does not contain fulltextPURPOSE: Depression is highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. Screening instruments could facilitate diagnosing depressive disorder in patients with advanced cancer. The aim of this study was to determine the validity of the Beck Depression Inventory (BDI-II) and a single screening question as screening tools for depressive disorder in advanced cancer patients. METHODS: Patients with advanced metastatic disease, visiting the outpatient palliative care department, were asked to fill out a self-questionnaire containing the Beck Depression Inventory (BDI-II) and a single screening question "Are you feeling depressed?" The mood section of the PRIME-MD was used as a gold standard. RESULTS: Sixty-one patients with advanced metastatic disease were eligible to be included in the study. Complete data were obtained from 46 patients. The area under the curve of the receiver operating characteristics analysis of the BDI-II was 0.82. The optimal cut-off point of the BDI-II was 16 with a sensitivity of 90% and a specificity of 69%. The single screening question showed a sensitivity of 50% and a specificity of 94%. CONCLUSIONS: The BDI-II seems an adequate screening tool for a depressive disorder in advanced cancer patients. The sensitivity of a single screening question is poor.1 februari 201

Farmacotherapie bij depressie

Dit is de tweede, geheel herziene druk van het Handboek depressieve stoornissen. Het geeft een up-to-date overzicht van zowel de wetenschappelijke als de behan­del­inhoudelijke kennis en ervaring rond deze veelvoorkomende, invaliderende en maatschappelijke relevante stoornis en sluit aan bij de DSM-5. Sinds de vorige druk uit 2008 is wereldwijd veel onderzoek verricht en werden vele nieuwe inzichten ten aanzien van ontstaan, preventie en behandeling van depressie ontwikkeld, die zijn meegenomen in het boek. Met oog voor de verschillende leeftijdsgroepen - jeugdigen, volwassenen en ouderen - worden de biologische, psychologische, sociale en culturele aspecten door een keur van ruim 60 Nederlandse en Vlaamse deskundigen in 32 hoofdstukken samengevat en besproken. Het boek is bedoeld voor de opleiding en bij- en nascholing van alle beroepsgroepen die met depressie te maken hebben, zoals verpleegkundigen, vaktherapeuten, huisartsen, bedrijfsartsen, psychologen, psychiaters, psychotherapeuten, verslavingsartsen, specialisten ouderengeneeskunde, maar zeker ook voor in depressie geïnteresseerde andere professionals, wetenschappers, patiënten en familie

Farmacotherapie bij depressie

Dit is de tweede, geheel herziene druk van het Handboek depressieve stoornissen. Het geeft een up-to-date overzicht van zowel de wetenschappelijke als de behan­del­inhoudelijke kennis en ervaring rond deze veelvoorkomende, invaliderende en maatschappelijke relevante stoornis en sluit aan bij de DSM-5. Sinds de vorige druk uit 2008 is wereldwijd veel onderzoek verricht en werden vele nieuwe inzichten ten aanzien van ontstaan, preventie en behandeling van depressie ontwikkeld, die zijn meegenomen in het boek. Met oog voor de verschillende leeftijdsgroepen - jeugdigen, volwassenen en ouderen - worden de biologische, psychologische, sociale en culturele aspecten door een keur van ruim 60 Nederlandse en Vlaamse deskundigen in 32 hoofdstukken samengevat en besproken. Het boek is bedoeld voor de opleiding en bij- en nascholing van alle beroepsgroepen die met depressie te maken hebben, zoals verpleegkundigen, vaktherapeuten, huisartsen, bedrijfsartsen, psychologen, psychiaters, psychotherapeuten, verslavingsartsen, specialisten ouderengeneeskunde, maar zeker ook voor in depressie geïnteresseerde andere professionals, wetenschappers, patiënten en familie