ABSTRACT
BACKGROUND: In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP). METHOD: One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist. RESULTS: The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists. CONCLUSIONS: Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.
Subject(s)
Depressive Disorder/diagnosis , Depressive Disorder/therapy , Education , Health Knowledge, Attitudes, Practice , Physicians, Family/education , Psychiatry/methods , Adolescent , Cost of Illness , Demography , Female , Humans , Latin America , Male , Mental Health AssociationsABSTRACT
OBJECTIVE: The American Regional Office of the WHO has launched a major initiative to reduce the prevalence of affective disorders region-wide that includes focusing on the primary health care system. This study evaluated the results of an educational training program for Brazilian primary care physicians that measured changes in knowledge, attitudes, and practice. METHODS: A total of 17 primary care physicians and 1,224 patients participated in the study. Physician's knowledge, attitudes, and clinical practice were assessed one-month prior and one-month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The training program showed limited benefits in this small sample of physicians. The program was unable to demonstrate benefit in improving knowledge about depression and in changing disorder-related attitudes. There were no changes in the diagnostic rates of major depression. There was some evidence to support improvement in psychopharmacological management. The physicians seemed more confident in treating patients, as there was a reduction of referrals to the specialists. Lack of statistical power prevented the latter two findings from reaching statistical significance. CONCLUSIONS: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression. However, more effective methods of training Brazilian primary care physicians in the management of major depression need to be tested.
Subject(s)
Depression/diagnosis , Education, Medical, Continuing/standards , Physicians, Family/education , Primary Health Care/standards , Chi-Square Distribution , Depression/therapy , Diagnostic and Statistical Manual of Mental Disorders , Female , Health Knowledge, Attitudes, Practice , Humans , International Classification of Diseases , Male , Middle Aged , Program Evaluation , Socioeconomic FactorsABSTRACT
OBJETIVO: Avaliar os resultados da aplicação de programa de treinamento da Organização Mundial de Saúde, voltado para diagnóstico e tratamento da depressão, dirigido a médicos clínicos gerais. MÉTODOS: Dezessete clínicos e 1.224 pacientes da cidade de Campinas, SP, participaram do estudo. Um mês antes e um após o treinamento, foram avaliados o conhecimento dos médicos, suas atitudes e o atendimento prestado aos pacientes; esses, por sua vez, completaram escalas de auto-avaliação de sintomas depressivos: Zung e um "checklist" para depressão maior do manual para diagnóstico e estatística em saúde mental (DSM-IV/CID-10). A mudança de conhecimento e atitude dos clínicos entre as fases 1 e 2 foi avaliada pelos testes t de Student. Mudanças com relação ao conhecimento de cada indivíduo foram mensuradas pelo teste de qui-quadrado de McNemar. As diferenças entre o modo de atender os pacientes entre as duas fases foram determinadas pelo teste de qui-quadrado de Pearson. A concordância diagnóstica foi analisada utilizando o Kappa, com o intuito de corrigir a concordância ao acaso. RESULTADOS: O programa mostrou benefícios limitados nessa amostra de clínicos gerais. Não foi capaz de mostrar aumento do conhecimento sobre a depressão e nem quanto à atitude dos médicos com relação a esse transtorno. Não houve modificação no número de casos diagnosticados antes ou após o programa. Existiram algumas evidências com relação à melhora no manejo psicofarmacológico. Aparentemente, o programa tornou os clínicos mais confiantes para o tratamento da depressão, diminuindo o número de encaminhamentos feitos aos profissionais da área de saúde mental. Porém, um baixo poder estatístico não permitiu que os dois últimos achados atingissem significância. CONCLUSÕES: A inclusão de clínicos gerais é um componente central de qualquer iniciativa para melhorar a detecção e o tratamento da depressão, porém faz-se necessário testar melhores métodos de treinamento dos clínicos brasileiros no manejo desta.
Subject(s)
Mentoring , Primary Health Care , Depression/diagnosis , Depression/therapy , Health Education , Health Knowledge, Attitudes, Practice , Physicians, FamilyABSTRACT
Trata-se de protocolo de investigacao de estudo multicentrico (O.M.S., CNPq, U.S.P., U.F.R.J., UNICAMP), no seu segundo ano de andamento em quatro municipios brasileiros: Santos, Campinas, Niteroi e Sao Paulo no Distrito Sanitario de Butanta; que inaugura no pais estudos de Determinacao de Qualidade de Servicos de Saude Mental, avaliando resultados atraves da opiniao de pacientes, familiares e trabalhadores de saude. O mesmo desenho de investigacao para todos os campos respeita caracteristicas locais e esta organizado em duas fases. Na primeira fase ha um mapeamento dos pacientes em uma 'semana tipica' dos servicos de saude mental nos municipios ou distritos estudados, estratificando-os por niveis de gravidade e padrao de utilizacao de servicos. Na segunda fase ha a aplicacao numa subamostra de pacientes, familias e universo de trabalhadores; utilizando instrumentos que consideram satisfacao com os servicos, qualidade de vida e autonomia/interdependencia social, contribuindo para a constituicao de indicadores eticos, tecnicos, tecnologicos e psicossociais de qualidade de servicos de saude mental.
