Barriers and opportunities for the treatment of mild-to-moderate depression with a watchful waiting approach.

OBJECTIVE: The aim of this study is to explore barriers and opportunities in non-pharmacological treatment of depression in primary care (PC) from the perspective of family physicians (FPs). METHODS: Qualitative analysis was used to explore a sample of 36 FPs treating patients with depressive symptoms. Criteria to maximize variability were followed. Participants were identified by key informants. Six group interviews were developed following a semi-structured thematic script. All interviews were transcribed, analyzed and triangulated. Information was saturated. Principals of reflexivity and circularity were implemented. RESULTS: The results obtained followed 3 main theoretical axes: the FP, the patient, the healthcare system, and the interaction between them. Barriers included poor alignment with clinical practice guidelines, inadequate FP training, patients' preferences and structural challenges in PC. Among opportunities were good FP clinical interview skills, the beneficial bond of trust between patients and FPs and improved communication with mental healthcare services. CONCLUSION: Based on FPs' perceptions, non-pharmacological treatment of depression in PC is particularly limited by lack of structured training; patients' preferences and treatment expectations; structural challenges in PC; and insufficient support from specialized mental health professionals. PRACTICE IMPLICATIONS: Resources for education, structural support in PC and modified back up from mental healthcare services are needed.

Reasons for medication non-initiation: A qualitative exploration of the patients' perspective.

BACKGROUND: Non-initiation occurs when the doctor prescribes a new pharmacological treatment to a patient who does not fill the prescription. Non-initiation prevalence estimates range between 6% and 28% in Primary Care (PC) and it is associated with poorer clinical outcomes, more sick-leave days and higher costs. To date, the reasons for non-initiation have not been explored using a qualitative framework. OBJECTIVE: The aim of the present study was to identify reasons for medication non-initiation among PC patients with distinct treatment profiles (acute, chronic symptomatic and asymptomatic, and mental disorders). METHODS: An exploratory, explanatory qualitative study based on Grounded Theory. We conducted individual semi-structured interviews with 30 PC patients. A constant comparative method of analysis was performed. RESULTS: The results were similar for all therapeutic groups. The decision to initiate treatment is multifactorial. Users make a risk-benefit assessment which is influenced by their beliefs about the pathology and the medication, their emotional reaction, health literacy and cultural factors. The patients' context and relationship with the health system influence decision-making. CONCLUSIONS: The decision to initiate a treatment is strongly influenced by factors that health professionals can discuss with patients. Health professionals should explore patients' beliefs about benefits and risks to help them make informed decisions and promote shared decision-making. General practitioners should ensure that patients understand the benefits and risks of disease and treatment, while explaining alternative treatments, encouraging patients to ask questions and supporting their treatment decisions.

Effectiveness of watchful waiting versus antidepressants for patients diagnosed of mild to moderate depression in primary care: A 12-month pragmatic clinical trial (INFAP study).

BACKGROUND: Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach. METHODS: The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis. RESULTS: We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales. CONCLUSIONS: Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.

[Do we really follow the Mediterranean diet?]. / Seguimos realmente una dieta mediterránea?

OBJECTIVE: To discover people's nutritional habits and their distance from the Mediterranean diet. DESIGN: Cross-sectional, descriptive study. SETTING: Gavà 2 Health District, Barcelona, Spain. PARTICIPANTS: 614 obtained at random from patients attending the centre. Stratified in 3 age groups (15-35, 36-64, and over 64). MAIN MEASUREMENTS: Validated questionnaire of the consumption by groups of food over the previous week. Then figures were compared with the standard values of the Mediterranean diet. RESULTS: Outstanding results were: 60% insufficiency in consumption of carbohydrates; 70.7% insufficiency in green vegetables, fruit and root vegetables; 75% of optimum consumption of pulses; 64% deficient consumption of milk products; 66% optimum consumption of fish; 73.8% optimum consumption of eggs; 71.2% proper intake of white meat; 64.2% excessive consumption of red meat and processed meats, which reached 86.6% among 15-35 year olds. There was a BMI over 25 in 59% of women and 63% of men, with obesity being most common among women and people over 64 years old. CONCLUSIONS: The population studied consumed an excessive amount of food with high contents of saturated fat, especially young people. There is a deficit in the intake of slowly absorbed carbohydrates and a less than ideal consumption of fruit, green vegetables and root vegetables, which was more marked among the young. The consumption of milk products was below the recommended amount. Pulses, fish and white meat were close to the right levels. This pattern is far from ideal and leads to higher risk of prevalent chronic illnesses.

¿Seguimos realmente una dieta mediterránea? / Do we really follow the mediterranean diet?

Objetivo. Conocer los hábitos alimentarios y su distanciamiento de la dieta mediterránea. Diseño. Estudio descriptivo, transversal. Emplazamiento. ABS Gavà 2. Barcelona. Participantes. Se incluyó a 614 pacientes obtenidos aleatoriamente de los pacientes que acudían al centro. La población fue estratificada en 3 franjas de edad (15-35, 36-64 y > 64 años). Mediciones principales. Cuestionario validado del consumo por grupos de alimentos en la última semana. Posteriormente se comparó con los valores estándar de dieta mediterránea. Resultados. Se observa un 60% de consumo insuficiente de hidratos de carbono, un 70,7% de consumo insuficiente de verduras, frutas y hortalizas, un 75% de consumo óptimo de legumbres, un 64% de consumo deficiente de lácteos, un 66% de consumo óptimo de pescado, un 73,8% de consumo óptimo de huevos, un 71,2% de consumo adecuado de carne blanca, y un 64,2% de consumo excesivo de carne roja y embutidos, que llega a ser del 86,6% a los 15-35 años. Se observó un IMC > 25 en el 59% de las mujeres y el 63% de los valores; la obesidad fue más frecuente en mujeres y en > 64 años. Conclusiones. La población estudiada consume un exceso de alimentos con alto contenido en grasas saturadas, especialmente los jóvenes. Hay un déficit en la ingesta de hidratos de carbono de absorción lenta y un consumo inferior al ideal de frutas, verduras y hortalizas, más acusado también en jóvenes. El consumo de lácteos es inferior al aconsejado. La ingesta de legumbres, pescado y carne blanca se aproxima a los niveles correctos. Este patrón difiere del ideal, lo que supone un mayor riesgo de enfermedades crónicas prevalentes

Setting. Gavà 2 Health District, Barcelona, Spain. Participants. 614 obtained at random from patients attending the centre. Stratified in 3 age groups (15-35, 36-64, and over 64). Main measurements. Validated questionnaire of the consumption by groups of food over the previous week. Then figures were compared with the standard values of the Mediterranean diet. Results. Outstanding results were: 60% insufficiency in consumption of carbohydrates; 70.7% insufficiency in green vegetables, fruit and root vegetables; 75% of optimum consumption of pulses; 64% deficient consumption of milk products; 66% optimum consumption of fish; 73.8% optimum consumption of eggs; 71.2% proper intake of white meat; 64.2% excessive consumption of red meat and processed meats, which reached 86.6% among 15-35 year olds. There was a BMI over 25 in 59% of women and 63% of men, with obesity being most common among women and people over 64 years old. Conclusions. The population studied consumed an excessive amount of food with high contents of saturated fat, especially young people. There is a deficit in the intake of slowly absorbed carbohydrates and a less than ideal consumption of fruit, green vegetables and root vegetables, which was more marked among the young. The consumption of milk products was below the recommended amount. Pulses, fish and white meat were close to the right levels. This pattern is far from ideal and leads to higher risk of prevalent chronic illnesses

Actividades preventivas y esquizofrenia. ¿Lo hacemos bien? / Preventive activities and esquizofreny. Do we do it well?

Fundamento : los esquizofrénicos son grandes frecuentadores en Atención Primaria, ¿aprovechamos para realizar actividades preventivas o se convierten en visitas burocráticas ? Objetivo : conocer si se practican las mismas actividades preventivas en esquizofrénicos que en población general.Diseño : estudio casos-controles .Material y métodos: casos (n=36): esquizofrénicos >15 años. Controles (n=72): extracción aleatoria de la base de datos, apareados por edad sexo .Variables: registro en HCAP de datos de filiación, frecuentación, actividades preventivas (peso, talla, vacuna antigripal, vacuna antitetánica, presión arterial, colesterolemia, alcohol y tabaco, según recomendaciones PAPPS) durante 1993-1998; recogida datos mayo-junio 1999.Explotación estadística: SPSS, estadística descriptiva de variables, Chi cuadrado o análisis de la varianza para análisis bivariante, odds ratio para medidas de asociación.Resultados : en el registro de actividades preventivas no hay diferencias estadísticamente significativas entre casos y controles, excepto mejor registro del hábito enólico (p=0,04) en los controles . Las actividades preventivas registradas, excepto hábito tabáquico, presentan mejores resultados en mujeres. Mejor registro de peso (p=0,01), talla (p=0,07), hábito alcohólico (p=0,04), mejor vacunadas de la gripe (p=0,006) y tétanos (p=0,03), y mejores resultados de cribado de colesterol (p=0,09) y presión arterial (p=0,005). Las mujeres son más frecuentadoras (6,8; DE:9,8) que los hombres (2,8; DE:3,2) (p=0,02). La mayor frecuentación se relaciona con un mejor re g i s t ro de vacuna antigripal (p=0,01), cribaje de c o l e s t e rol (p=0,05), peso (p=0,02), talla (p=0,04) y hábito enólico (p=0,03).Conclusiones : no se observan diferencias en la práctica de actividades preventivas entre esquizofrénicos y población general, siendo en ambos muy bajo el registro (AU)