The current maxim concerning diagnosis and treatment of mood and anxiety disorders is that family physicians fail to appropriately respond to patients with anxiety and depression. This estimate is based upon a collection of studies that have found that accurate recognition in general practice occurred in 9% to 75% of patients with depression, and 34% to 50% of patients with anxiety. However, most studies have found that more than half of physicians accurately detected depression and anxiety in their patients.<p>
This dissertation examined physicians responses (detection, treatment, and follow-up) to clinical scenarios of patients presenting with symptoms of either depression or anxiety. Furthermore, this study evaluated the associations between physicians responses and physician attributes (personal and professional), organizational setting, information/resource use, and barriers to care.<p>
A cross-sectional study of Saskatchewan family physicians yielded a response rate of 49.7% (N=331/666). The results of this study revealed that most physicians provided appropriate depression and anxiety care with respect to recognition of disorders and follow-up care. Specifically, 85.4% of physicians provided an accurate tentative diagnosis of depression, and 86.3% provided an accurate tentative diagnosis of anxiety; 82.5% of physicians suggested adequate follow-up depression care while 79.4% offered adequate follow-up anxiety care. However, a notable proportion of physicians did not provide effective treatment; 65.6% of physicians recommended effective (immediate) anxiety treatment, and 55.6% recommended effective (immediate) depression treatment.<p>
This study found that physicians provision of care to patients with anxiety and depression was more likely to be associated with their personal attributes, organizational setting, and information/resource use than with their professional attributes. First, neither tentative diagnosis of depression nor tentative diagnosis of anxiety was significiantly associated with any of the tested measures. Second, ineffective treatment of depression was significantly more likely among physicians who were female, educated at the undergraduate level in Canada (versus elsewhere), scored lower on anxiety attitude factor 1 (social context view of anxiety amenable to intervention), had a low patient load (< 100 patients/week), and used medical textbooks to make specific clinical decisions; ineffective treatment of anxiety was significantly more likely among physicians who had completed their undergraduate and postgraduate medical training in Canada (versus elsewhere), had a low patient load ( <100 patients/week), did not practice in a private office/clinic, and used colleagues within as well as outside their main patient care setting to update their general medical knowledge. Third, physicians were significantly more likely to provide inadequate follow-up care to the depressed patient if they were in solo practice and used drug manuals to update their general medical knowledge, and significantly more likely to provide inadequate follow-up care to the anxious patient if they (the physician) were female and did not use mental health professionals to update their general medical knowledge.<p>
Results indicated that after controlling for the effects of other factors, physicians with low patient loads were three times more likely to provide ineffective treatment of depression than physicians with high patient loads. Furthermore, when holding the effects of all other factors constant, physicians who had completed postgraduate training in Canada were approximately five times more likely to provide ineffective treatment of the anxious patient than physicians who had completed their postgraduate training outside of Canada.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:SSU.etd-09162009-151334 |
| Date | 17 September 2009 |
| Creators | Kosteniuk, Julie |
| Contributors | Mousseau, Darrell, Bland, Roger, Tempier, Raymond, Shah, Syed, Morgan, Debra, D'Arcy, Carl |
| Publisher | University of Saskatchewan |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://library.usask.ca/theses/available/etd-09162009-151334/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Saskatchewan or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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