A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK

Margaret Maxwell, Fiona Harris, Carina Hibberd, Eddie Donaghy, Rebekah Pratt, Chris Williams, Jill Morrison, Jennifer Gibb, Philip Watson, Chris Burton

Research output: Contribution to journalArticle

21 Citations (Scopus)
5 Downloads (Pure)

Abstract

Background
Routinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.

Methods
Two complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.

Results
We identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.

Conclusion
The introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.
Original languageEnglish
Article number46
JournalBMC Family Practice
Volume14
DOIs
Publication statusPublished - 4 Apr 2013

Fingerprint

Coronary Disease
Primary Health Care
Nurses
Depression
Mental Health
Chronic Disease
Scotland
Focus Groups
Referral and Consultation
Health

Keywords

  • Cluster Analysis
  • Community-Institutional Relations
  • Coronary Disease
  • Counseling
  • Depressive Disorder
  • Focus Groups
  • Humans
  • Mass Screening
  • Nurse's Practice Patterns
  • Nurses
  • Observer Variation
  • Outcome and Process Assessment (Health Care)
  • Physician's Practice Patterns
  • Physicians
  • Primary Health Care
  • Professional-Patient Relations
  • Qualitative Research
  • Questionnaires
  • Scotland

Cite this

A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK. / Maxwell, Margaret; Harris, Fiona; Hibberd, Carina; Donaghy, Eddie; Pratt, Rebekah; Williams, Chris; Morrison, Jill; Gibb, Jennifer; Watson, Philip; Burton, Chris.

In: BMC Family Practice, Vol. 14, 46, 04.04.2013.

Research output: Contribution to journalArticle

Maxwell, Margaret ; Harris, Fiona ; Hibberd, Carina ; Donaghy, Eddie ; Pratt, Rebekah ; Williams, Chris ; Morrison, Jill ; Gibb, Jennifer ; Watson, Philip ; Burton, Chris. / A qualitative study of primary care professionals' views of case finding for depression in patients with diabetes or coronary heart disease in the UK. In: BMC Family Practice. 2013 ; Vol. 14.
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abstract = "BackgroundRoutinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.MethodsTwo complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.ResultsWe identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.ConclusionThe introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.",
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AU - Harris, Fiona

AU - Hibberd, Carina

AU - Donaghy, Eddie

AU - Pratt, Rebekah

AU - Williams, Chris

AU - Morrison, Jill

AU - Gibb, Jennifer

AU - Watson, Philip

AU - Burton, Chris

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N2 - BackgroundRoutinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.MethodsTwo complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.ResultsWe identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.ConclusionThe introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

AB - BackgroundRoutinely conducting case finding (also commonly referred to as screening) in patients with chronic illness for depression in primary care appears to have little impact. We explored the views and experiences of primary care nurses, doctors and managers to understand how the implementation of case finding/screening might impact on its effectiveness.MethodsTwo complementary qualitative focus group studies of primary care professionals including nurses, doctors and managers, in five primary care practices and five Community Health Partnerships, were conducted in Scotland.ResultsWe identified several features of the way case finding/screening was implemented that may lead to systematic under-detection of depression. These included obstacles to incorporating case finding/screening into a clinical review consultation; a perception of replacing individualised care with mechanistic assessment, and a disconnection for nurses between management of physical and mental health. Far from being a standardised process that encouraged detection of depression, participants described case finding/screening as being conducted in a way which biased it towards negative responses, and for nurses, it was an uncomfortable task for which they lacked the necessary skills to provide immediate support to patients at the time of diagnosis.ConclusionThe introduction of case finding/screening for depression into routine chronic illness management is not straightforward. Routinized case finding/screening for depression can be implemented in ways that may be counterproductive to engagement (particularly by nurses), with the mental health needs of patients living with long term conditions. If case finding/screening or engagement with mental health problems is to be promoted, primary care nurses require more training to increase their confidence in raising and dealing with mental health issues and GPs and nurses need to work collectively to develop the relational work required to promote cognitive participation in case finding/screening.

KW - Cluster Analysis

KW - Community-Institutional Relations

KW - Coronary Disease

KW - Counseling

KW - Depressive Disorder

KW - Focus Groups

KW - Humans

KW - Mass Screening

KW - Nurse's Practice Patterns

KW - Nurses

KW - Observer Variation

KW - Outcome and Process Assessment (Health Care)

KW - Physician's Practice Patterns

KW - Physicians

KW - Primary Health Care

KW - Professional-Patient Relations

KW - Qualitative Research

KW - Questionnaires

KW - Scotland

U2 - 10.1186/1471-2296-14-46

DO - 10.1186/1471-2296-14-46

M3 - Article

C2 - 23557512

VL - 14

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

M1 - 46

ER -