Treatment of depressive patients in general practice: The effects of a short training course in the practice orientation of general practitioners

Abstract

The objective of this study was to assess the changes after a short training course in the practice orientation of general practitioners (GPs) in diagnosing and treating patients with depression. A controlled intervention study design was used, with pre- and post-intervention measurements. The intervention was conducted in four health care centers in Finland. One health care center functioned as the control. The intervention was a 3-day training course, targeted at all the staff of the intervention health care centers. It included lectures on depression and practice in small groups, focusing especially on patient-caregiver relationships and interaction. Both in the intervention and in the control health care centers all patients were screened for depression during 1 week before and 4 months after the training. The agreement on the patients' depressive status was measured by comparing the patients' Beck Depression Inventory (BDI) scores with the GPs' assessments. Practice orientation was evaluated from descriptions given by the treating GPs. In the intervention health care centers 18% (210 of 1154) of the patients in the pretest phase and 17% (132 of 799) in the posttest phase were indicated as depressed by the BDI. Contrary to expectations, the GPs' originally low sensitivity (in comparison with the BDI) in detecting depression decreased even somewhat more after the training course (17.1%/11.4%). However, the practice changed slightly from being symptom-oriented toward being patient- or even family-oriented in the intervention health care centers.