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So today I will be talking about an article that I found from www.pubmed.com, which is a highly reputable search engine for the latest medical research. Upon looking up research articles , I stumbled across one that seemed quite interesting. This article is called "Treatment and follow-up of anxiety and depression in clinical-scenario patients." If you would like to read the entire article, you can find it here . I will just be going over the objective, methods, results, and conclusions from this article to help you understand it better.
Firstly, as I did mention in my last blog post about the reliability of family physicians , it seems interesting to explore their recommendations for treatments to depression. So the objective of this first follow up visit of clinical-scenario patients presenting with symptoms of a major depressive episode or generalized anixiety disorder is to analyze family physician's recommendations for treatment to these patients as well as their perceived barriers to these patients.
From a pilot study of 100 Saskatchewan family physicians and locum tenens physicians conducted from June-October 2007, Physicians received an 8 page questionnaire that included 5 parts which included reviewing clinical scenarios in which patients were presented with common psychiatric disorders. In total, 331 physcians had participated in the survey with completed questionnaires.
These were the results of the treatment part of survey:
| TREATMENT PLAN | GAD CLINICAL SCENARIO (N = 160), N (%) | MDE CLINICAL SCENARIO (N = 171), N (%) |
|---|---|---|
| Immediate* | ||
| • Pharmacotherapy alone | 42 (26.3) | 22 (12.9) |
| • Counseling† alone | 6 (3.8) | 12 (7.0) |
| • Pharmacotherapy and counseling | 40 (25.0) | 27 (15.8) |
| • Pharmacotherapy or counseling plus other‡ | 14 (8.8) | 18 (10.5) |
| • Other alone | 3 (1.9) | 16 (9.4) |
| • Total immediate | 105 (65.6) | 95 (55.6) |
| Delayed | ||
| • Pharmacotherapy alone | 12 (7.5) | 7 (4.1) |
| • Counseling† alone | 3 (1.9) | 1 (0.6) |
| • Pharmacotherapy and counseling | 3 (1.9) | 6 (3.5) |
| • Pharmacotherapy or counseling plus other‡ | 2 (1.3) | 3 (1.8) |
| • Other alone | 0 | 1 (0.5) |
| • Await results before deciding | 25 (15.6) | 41 (24.0) |
| • Total delayed | 45 (28.1) | 59 (34.5) |
| No treatment | 3 (1.9) | 2 (7.0) |
| No response | 7 (4.4) | 5 (2.9) |
To sum this table up, for the Generalized anxiety disorder scenario patient, it shows that majority of the physicians recommend immediate treatment but not pharmacotherapy. Only 28.1% suggest delayed treatment. For the major depressive episode patient, most physicians suggest immediate treatment of a combination of pharmacotherapy and counseling. 34.5% had suggest delayed treatment. In addition, most physicians recommend for the patients to have the first follow up visit after 2 weeks.
And here were the results of the barriers portion of the survey:
| BARRIERS TO CARE | GAD CLINICAL SCENARIO (N = 160), N (%) | MDE CLINICAL SCENARIO (N = 171), N (%) |
|---|---|---|
| Any barrier mentioned* | 107 (66.9) | 111 (64.9) |
| Physician-related barriers | ||
| • Too busy | 28 (17.5) | 27 (15.8) |
| • Requires specialist referral or consultation | 12 (7.5) | 11 (6.4) |
| • Does not provide counseling | 8 (5.0) | 6 (3.5) |
| • Needs more information | 4 (2.5) | 7 (4.1) |
| • Cannot immediately diagnose | 1 (0.6) | 9 (5.3) |
| • Needs to rule out organic cause | 2 (1.3) | 5 (2.9) |
| • Diagnostic uncertainty | 3 (1.9) | 3 (1.8) |
| • Lacks knowledge, skills, or experience | 10 (6.3) | 1 (0.6) |
| • Other | 7 (4.4) | 14 (8.2) |
| • Any physician barrier | 63 (39.4) | 68 (39.8) |
| Patient-related barriers | ||
| • Noncompliant | 16 (10.0) | 21 (12.3) |
| • Resists diagnosis | 6 (3.8) | 9 (5.3) |
| • Cannot afford treatment | 5 (3.1) | 7 (4.1) |
| • Complex condition | 6 (3.8) | 2 (1.2) |
| • Condition persists | 3 (1.9) | 6 (3.5) |
| • Drug addiction | 7 (4.4) | 1 (0.6) |
| • Suicidal | 4 (2.5) | 3 (1.8) |
| • History incomplete | 2 (1.3) | 3 (1.8) |
| • Wants physical diagnosis | 2 (1.3) | 1 (0.6) |
| • Condition is comorbid | 2 (1.3) | 1 (0.6) |
| • Other | 1 (0.6) | 3 (1.8) |
| • Any patient barrier | 40 (25.0) | 36 (21.1) |
| System access–related barriers | ||
| • Counseling | 14 (8.8) | 16 (9.4) |
| • Psychiatrist | 7 (4.4) | 8 (4.7) |
| • Laboratory results | 3 (1.9) | 8 (4.7) |
| • Specialist | 1 (0.6) | 4 (2.3) |
| • CBT provider | 3 (1.9) | 2 (1.2) |
| • Other | 6 (3.8) | 7 (4.1) |
| • Any system barrier | 30 (18.8) | 36 (21.1) |
| No response | 53 (33.1) | 60 (35.1) |
To conclude, what can we take from this article?
Well from these findings in the survey we can learn that family physicians are less likely to wait for patients with symptoms of common psychiatric disorders are are more likely to recommend pharmacotherapy and counseling. Most of them suggest a 2 week follow up which is a good amount of time. However, some physicians seem to identity their barriers as themselves. It is quite interesting to note that most physicians may lack the knowledge and skills to treat these kinds of patients which is why in my previous blog I mentioned that physicians may overprescribe antidepressants. Recall that in my last blog post I talked about this article which was also found on pubmed.
Furthermore, I hope this article seemed of interest to you and I hope this post helped!
Good luck and take care,
Vivian
