Patients' and doctors' views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study
Open Access
- 19 March 2009
- Vol. 338 (mar19 1), b663
- https://doi.org/10.1136/bmj.b663
Abstract
Objective To gain understanding of general practitioners’ and patients’ opinions of the routine introduction of standardised measures of severity of depression through the UK general practice quality and outcomes framework. Design Semistructured qualitative interview study, with purposive sampling and constant comparative analysis. Participants 34 general practitioners and 24 patients. Setting 38 general practices in three sites in England: Southampton, Liverpool, and Norfolk. Results Patients generally favoured the measures of severity for depression, whereas general practitioners were generally cautious about the validity and utility of such measures and sceptical about the motives behind their introduction. Both general practitioners and patients considered that assessments of severity should be seen as one aspect of holistic care. General practitioners considered their practical wisdom and clinical judgment (“phronesis”) to be more important than objective assessments and were concerned that the assessments reduced the human element of the consultation. Patients were more positive about the questionnaires, seeing them as an efficient and structured supplement to medical judgment and as evidence that general practitioners were taking their problems seriously through a full assessment. General practitioners and patients were aware of the potential for manipulation of indicators: for economic reasons for doctors and for patients to avoid stigma or achieve desired outcomes. Conclusions Despite general practitioners’ caution about measures of severity for depression, these may benefit primary care consultations by increasing patients’ confidence that general practitioners are correct in their diagnosis and are making systematic efforts to assess and manage their mental health problems. Further education of primary care staff may optimise the use and interpretation of depression questionnaires.Keywords
This publication has 8 references indexed in Scilit:
- Exclusion of Patients from Pay-for-Performance Targets by English PhysiciansNew England Journal of Medicine, 2008
- Effects of payment for performance in primary care: Qualitative interview studyJournal of Health Services Research & Policy, 2008
- Education and the changing face of medical professionalism: from priest to mountain guide?British Journal of General Practice, 2008
- The treatment of common mental health problems in general practiceFamily Practice, 2005
- A qualitative examination of primary care providers’ and physician managers’ uses and views of research evidenceInternational Journal for Quality in Health Care, 2005
- Development and Validation of the Patient Assessment of Chronic Illness Care (PACIC)Medical Care, 2005
- Patients' opinions of the use of psychiatric case-finding questionnaires in general practiceHealth Expectations, 2002
- Interpreting health outcomesJournal of Evaluation in Clinical Practice, 1997