Improving general practitioners’ interviewing skills in managing patients with depression and anxiety: a randomized controlled clinical trial

Abstract

Background: Studies regarding the effectiveness of CME programmes on physicians’ behaviour and communication skills showed inconsistent results. Few randomized controlled trials have been conducted in Asia.

Methods: To evaluate the effectiveness of a 4 2-hour education programme to improve GP interviewing behaviours, 16 general practitioners were randomized to the intervention and control groups, respectively. Physicians assigned to the intervention group received 8 hours of training emphasizing interviewing behaviours in the diagnosis and treatment of depression and generalized anxiety disorders (GDS). Those assigned to the control group did not receive any training until the completion of study. Standardized patients were used to evaluate the performance of physicians. Two consultations before and after enrolling in the education programme were videotaped. Independent evaluations of consultations were made by a trained clinical psychologist and a social worker blinded to the study status of physicians. The rating schedule for the videotapes was based on the tasks listed on the Calgary Cambridge Observation Guide.

Results: The change of score between the intervention and control physicians was significantly different in ‘active listening and facilitating patients’ response’ (p = 0.011) with the intervention physicians having improvement of score. For ‘non-verbals’, ‘understanding patient's perspective’ and ‘negotiating mutual plan of action’, positive change of score in the intervention physicians were seen when compared to that of the control, although the difference did not reach statistical significance (p = 0.06, p = 0.05, p = 0.06, respectively). However, for ‘opening’, ‘structuring the consultation’, ‘explanation and planning’ and ‘closure’, there were no statistical significant differences between control and intervention group.

Conclusions: Our results showed that only certain communication skills, such as active listening and facilitating patient's response, can be taught in the management of depression and generalized anxiety disorder (GAD) in Chinese primary care physicians.

Additional information

Notes on contributors

S. Y. S. Wong

Dr SAMUEL YEUNG SHAN WONG, MD, CCFPC, FRACGP, is an assistant professor in the Department of Community and Family Medicine, the Chinese University of Hong Kong. His research interests cover psychosocial/psychosomatic medicine in primary care, men's health include prostatic diseases and psychosocial issues in men.

A. K. Y. Cheung

Dr ANDY KIT YING CHEUNG, MBBS(HK),FRACGP, FHKAM (Family Medicine), SocSc (Couns) South Australia, is a family physician in private practice and part time professional clinical consultant in the Department of Community and Family Medicine, the Chinese University of Hong Kong. Her special interests include psychological medicine, communication and counseling.

A. Lee

PROFESSOR ALBERT LEE is Professor and Head of Family Medicine Unit of Department of Community and Family Medicine. He is also the Director of Postgraduate Programme in Family Medicine and started the first Master degree in Family Medicine in Hong Kong. He is involved in training of practising family physicians in Hong Kong and neighbouring countries. Primary health care development and community mental health promotion are his major areas of research interest.

N. Cheung

NANCY M. Y. CHEUNG is a social worker (BSocSc, MSocSc) and family mediator (HKIAC). She is now a part-time lecturer with the Department of Social Work of the Chinese University of Hong Kong and a private practitioner in counseling and family mediation.

A. Leung

Dr ANITA C. LEUNG, FHKPS, Clinical Psychologist in private practice, Adjunct Assistant Professor, Psychology Department, The Chinese University of Hong Kong.

W. Wong

Dr WILLIAM CW WONG, MB ChB, MA (Dist.), DFFP, DCH, DHCL, MMFTM, RCPS, MRCGP, is an Assistant Professor in Community & Family Medicine at the Chinese University of Hong Kong. He is the undergraduate coordinator for family medicine and his research interests include sexual health and its global impact as well as alternative medicine. He has published over 50 papers and the results of these researches were disseminated to the general public through 32 newspaper reports and, two radio and TV interviews.

K. Chan

KENNETH CHAN, BSocSc, was a Research Assistant in the Department of Community and Family Medicine, The Chinese University of Hong Kong.