Attitudes of family doctors towards managing depressive patients in primary health care, Kuwait

Depression is one of the most common single reasons for attending a general practitioner clinic and the majority of depressed people who receive treatment do so in primary care. This study aimed at assessing family physicians [FPs] attitudes in the recognition and management of depression and their opinions about factors that may influence their manner of work with depressive patients. The study design is a cross sectional descriptive one that was conducted from June to August 2006 including all FPs who were currently working in primary care centers in Kuwait and available during the study period. A self-administered questionnaire was distributed to all FPs including data on their personal characteristics, perception towards certain aspects of depressed patients, availability of service facilities for diagnosis and management of depressed patients, and their opinions about factors that may affect coping with them. Simple descriptive statistics were used. Out of 122 distributed questionnaires, 110 were returned back with 90.2% response rate. The study revealed that 75.4% of FPs stated that the number of depressed patients is increasing, 47.2% felt that working with depressed patients is a burden, and about one third of the participants agreed that primary care is the suitable place for managing them. The majority of FPs declared that they have the ability to prescribe antidepressants and selective serotonin reuptake inhibitors was the drug of choice. The majority of FPs were frustrated about availability of service facilities for diagnosis and management of depression. Most of them agreed about the importance of patients' attitude towards management. Previous clinical experience and personal qualities were ranked on the top of the list of physicians' factors. Concerning system-related factors, 89.1%, 86.8%, 79.1% of FPs agreed about the importance of available protocol, attending courses on communication skills and referral of patients to social workers respectively. In their conceptions of factors that form their way to treat depressed patients, FPs were unsatisfied about availability of services for managing depression and they tend to emphasize their experiences. Interventions to improve depression management have to be supporting and interactive and combined with organizational reforms to improve cooperation with psychiatrists and communication skill of FPs

Effectiveness of self monitoring of blood glucose on glycaemic control among diabetic patients

Self monitoring of blood glucose [SMBG] is becoming of great importance for self management of diabetes mellitus. This study was formulated to detect the impact of decreased SMBG on glycaemic control among diabetic patients. The design of this study was a cross-sectional one. A sample size of 526 diabetic patients was selected from a diabetes clinic to reveal the impact of SMBG on fasting blood glucose and glycated haemoglobin A1c. The structured interview technique was adopted to collect both socio-demographic and clinical data of diabetic patients in addition to a fasting blood sample. Out of the total sample, 59.7% were performing SMBG, while only 18.6% were monitoring using this technique according to the recommended standard. Users of SMBG were more likely to have controlled fasting blood glucose [29.9% compared with 20.8%, P = 0.09] and controlled HbA1c [25.5% compared with 6.6%, P < 0.001] than non users. This impact was also evident after adjusting for the confounding factors. A decreasing trend in FBG was demonstrated with increased frequency of SMBG. Older age, higher level of education and positive family history proved to be significant predictors for using SMBG. SMBG can help diabetic patients to achieve a better glycaemic control especially if it is used in the recommended frequency. SMBG should be encouraged among all diabetic patients