- IDENTIFYING PHYSICIANS MOST LIKELY TO BENEFIT FROM DEPRESSION
MS Gerrity, JW Williams, AJ Dietrich. Departments of Medicine,
Oregon Health Sciences University, Portland, OR and University
of Texas at San Antonio, and Department of Community and Family
Medicine, Dartmouth Medical School, Hanover, NH.
Purpose: Primary care physicians see many patients with depression;
yet, they may miss the diagnosis or under treat the patient. Methods
to identify physicians most likely to benefit from educational
programs to improve care of depressed patients have not been developed.
We used data from a national survey to develop measures to identify
Method: A 53-item questionnaire was mailed to a national sample
of 2,308 family physicians, general internists, and obstetrician-gynecologists
who spent at least 50% of their time seeing continuity patients.
We used exploratory factor analysis (EFA) to identify factors
underlying physicians responses to 35 attitude items. We named
the factors and selected items with loading> 0.40 for the final
scales. After collapsing the ratings of each item into dichotomous
responses (0 versus 1), we scored the scales by summing physicians'
responses to each item. Cronbach's alpha was used to assess reliability.
Using a separate physician validation sample, physicians' scores
on the scales were compared to actual behavior with unannounced
standardized patients and to their scale scores after attending
a workshop on depression.
Results: 1,350 (58%) of physicians returned questionnaires. Respondents
spent a median of 11 years in practice, 50% were female, 46% family
physicians, 35% general internists, and 19% obstetrician-gynecologists.
EFA identified 2 factors that we named Confidence in Caring for
Depressed Patients (8 items, alpha = .78) and Intention to Change
(6 items). Twenty-nine percent of family physicians, 54% of general
internists, and 88% of obstetrician-gynecologists reported not
being confident (scale score (7) in caring for depressed patients.
For all specialties, 64% intended to change some aspect of their
care of depressed patients. Of those physicians who were not confident,
preliminary data suggest that 25% - 30% are very likely to attend
an educational program about depression in the next 6 months.
Based on standardized patient observations for the validation
sample, physicians who were not confident in caring for depressed
patients were less likely to ask about the criteria for depression,
discuss depression , prescribe anti-depressants, and schedule
a return visit within 2 weeks Physicians scores on the Confidence
scale changed significantly after attending a workshop on depression.
Conclusion: The Confidence in Caring for Depressed Patients scale
is a reliable and valid measure that can be used to identify physicians
most likely to benefit from educational programs about depression.
Furthermore, the majority of general internists and obstetricians
do not feel confident in their care of depressed patients.