Published 19 March 2009, doi:10.1136/bmj.b663
Cite this as: BMJ 2009;338:b663

Research

Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study

¹ University of Liverpool School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool L69 3GB, ² University of Southampton Primary Medical Care Group, Aldermoor Health Centre, Southampton SO16 5ST, ³ University of East Anglia School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ

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.

© Dowrick et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data

Tony Kendrick, Christopher Dowrick, Anita McBride, Amanda Howe, Pamela Clarke, Sue Maisey, Michael Moore, and Peter W Smith
BMJ 2009 338: b750. [Abstract] [Full Text] [PDF]

Treatment of depression in primary care

Chris van Weel, Evelyn van Weel-Baumgarten, and Eric van Rijswijk
BMJ 2009 338: b934. [Extract] [Full Text]

This article has been cited by other articles:

• (2009). Depression-Rating Scales in Primary Care: Time for a Change?. JWatch Psychiatry 2009: 1-1 [Full text]  
• Kendrick, T., Dowrick, C., McBride, A., Howe, A., Clarke, P., Maisey, S., Moore, M., Smith, P. W (2009). Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. BMJ 338: b750-b750 [Abstract] [Full text]  
• Weel, C. v., Weel-Baumgarten, E. v., Rijswijk, E. v. (2009). Treatment of depression in primary care. BMJ 338: b934-b934 [Full text]  

Rapid Responses:

Read all Rapid Responses

Over-incentivising general practice

Jo Richardson
bmj.com, 28 Mar 2009 [Full text]

Routine use of clinical measures: a common issue with doctors

Saji S Damodaran
bmj.com, 11 Apr 2009 [Full text]

Online poll

Find out more on doc2doc >>