Gask Linda, Dixon Clare, May Carl, Dowrick Chris
School of Primary Care, University of Manchester.
Br J Gen Pract. 2005 Nov;55(520):854-9.
Previous research has not shown any significant health gain for patients as a result of providing education about depression for GPs. Reasons for this, however, are unclear.
To explore relationships between process and outcome in the setting of a randomised controlled trial of a complex educational intervention designed to provide GPs with training in the assessment and management of depression.
Qualitative study utilising semi-structured interviews.
General practice in the northwest of England.
Semi-structured interviews with 30 GPs in Liverpool and Manchester who participated in a randomised controlled trial.
Three major barriers to the effectiveness of the intervention were identified: the lack of the GP's belief that he/she could have an impact on the outcome of depression, the appropriateness of the training, and the organisational context in which doctors had to implement what they had learned.
Attitudes toward treating depression may need addressing at a much earlier point in medical education. If students are introduced to a biosocial model of depression at an early stage, they may feel more hopeful about their ability to intervene when faced with patients who exhibit significant degrees of functional disability in the context of apparently socially determined disorders. Postgraduate interventions should be tailored to the treatment of depression as a common chronic condition and be focused at the level of the organisation, not the individual practitioner.
先前的研究并未表明，向全科医生提供抑郁症相关教育能给患者带来任何显著的健康益处。然而，其原因尚不清楚。
在一项旨在为全科医生提供抑郁症评估与管理培训的复杂教育干预随机对照试验中，探讨过程与结果之间的关系。
采用半结构化访谈的定性研究。
英格兰西北部的全科医疗。
对利物浦和曼彻斯特参与随机对照试验的30名全科医生进行半结构化访谈。
确定了干预效果的三个主要障碍：全科医生缺乏其自身能够对抑郁症治疗结果产生影响的信念、培训的适宜性，以及医生必须将所学知识付诸实践的组织环境。
在医学教育的更早阶段可能就需要解决对抑郁症治疗的态度问题。如果学生在早期就接触到抑郁症的生物社会模型，那么当面对在明显由社会因素导致的疾病中表现出严重功能障碍的患者时，他们可能会对自己的干预能力更有信心。研究生阶段的干预措施应针对抑郁症这一常见慢性病的治疗进行调整，并聚焦于组织层面，而非个体从业者。
