Reinvention of depression instruments by primary care clinicians
| Autor: | Jeffrey Susman, Seong-Yi Baik, Jean Anthony, Bas Tidjani, Barbara J. Bowers, Junius J. Gonzales |
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| Rok vydání: | 2010 |
| Předmět: |
Psychometrics
Nurse practitioners Decision Making Context (language use) Resistance (psychoanalysis) Primary care Grounded theory Nursing Surveys and Questionnaires Interview Psychological Medicine Humans Mass Screening Practice Patterns Physicians' Depression (differential diagnoses) Quality of Health Care Original Research Primary Health Care business.industry Depression Data Collection Focus Groups Objective Evidence Focus group Diffusion of Innovation Family Practice business |
| Zdroj: | Annals of family medicine. 8(3) |
| ISSN: | 1544-1717 |
| Popis: | PURPOSE Despite the sophisticated development of depression instruments dur- ing the past 4 decades, the critical topic of how primary care clinicians actually use those instruments in their day-to-day practice has not been investigated. We wanted to understand how primary care clinicians use depression instruments, for what purposes, and the conditions that infl uence their use. METHODS Grounded theory method was used to guide data collection and anal- ysis. We conducted 70 individual interviews and 3 focus groups (n = 24) with a purposeful sample of 70 primary care clinicians (family physicians, general inter- nists, and nurse practitioners) from 52 offi ces. Investigators' fi eld notes on offi ce practice environments complemented individual interviews. RESULTS The clinicians described occasional use of depression instruments but reported they did not routinely use them to aid depression diagnosis or man- agement; the clinicians reportedly used them primarily to enhance patients' acceptance of the diagnosis when they anticipated or encountered resistance to the diagnosis. Three conditions promoted or reduced use of these instruments for different purposes: the extent of competing demands for the clinician's time, the lack of objective evidence of depression, and the clinician's familiarity with the patient. No differences among the 3 clinician groups were found for these 3 conditions. CONCLUSIONS Depression instruments are reinvented by primary care clinicians in their real-world primary care practice. Although depression instruments were originally conceptualized for screening, diagnosing, or facilitating the manage- ment of depression, our study suggests that the real-world practice context infl uences their use to aid shared decision making—primarily to suggest, tell, or convince patients to accept the diagnosis of depression. |
| Databáze: | OpenAIRE |
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