Pierce David, Gunn Jane
Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia.
BMC Fam Pract. 2007 Apr 25;8:24. doi: 10.1186/1471-2296-8-24.
Depression is a major health concern, predominantly treated by general practitioners (GPs). Problem solving therapy (PST) is recognised as an effective treatment for depression that is not widely used by GPs. This research aims to explore barriers and enablers that may influence GPs use of this treatment.
Qualitative methodology was used including individual and focus group interviews of GPs, PST experts and consumers. Analysis was undertaken using the Theory of Planned Behaviour (TPB) as a framework.
A spectrum of potential influences, on GPs' use of PST emerged. Both barriers and enablers were identified. PST was perceived as being close to current practice approaches and potentially beneficial to both doctor and patient. In addition to a broadly positive attitude to PST, expressed by those with previous experience of its use, potential solutions to perceived barriers emerged. By contrast some GPs expressed fear that the use of PST would result in loss of doctor control of consultations and associated potential adverse patient outcomes. Patient expectations, which emerged as not always coinciding with GPs' perception of those expectations, were identified as a potential influence on GPs' decision concerning adoption of PST. In addition specific factors, including GP skill and confidence, consultation time constraints and technical issues related to PST were noted as potential concerns.
This research contributes to our knowledge of the factors that may influence GPs' decisions regarding use of PST as a treatment for depression. It recognises both barriers and enablers. It suggests that for many GPs, PST is viewed in a positive light, providing encouragement to those seeking to increase the provision of PST by GPs. In identifying a number of potential barriers, along with associated options to address many of these barriers, it provides insights which may assist in the planning of GP training in PST.
抑郁症是一个主要的健康问题，主要由全科医生（GP）进行治疗。问题解决疗法（PST）被认为是一种治疗抑郁症的有效方法，但全科医生并未广泛使用。本研究旨在探讨可能影响全科医生使用这种治疗方法的障碍和促进因素。
采用定性研究方法，包括对全科医生、PST专家和患者进行个人访谈和焦点小组访谈。以计划行为理论（TPB）为框架进行分析。
出现了一系列可能影响全科医生使用PST的潜在因素。既确定了障碍，也确定了促进因素。PST被认为与当前的实践方法相近，对医生和患者都可能有益。除了那些有使用PST经验的人对其持广泛积极态度外，还出现了针对感知到的障碍的潜在解决方案。相比之下，一些全科医生表示担心使用PST会导致医生失去对会诊的控制以及相关的潜在不良患者后果。患者期望被确定为对全科医生采用PST的决定的潜在影响因素，而患者期望并不总是与全科医生对这些期望的认知一致。此外，还指出了一些具体因素，包括全科医生的技能和信心、会诊时间限制以及与PST相关的技术问题等潜在问题。
本研究有助于我们了解可能影响全科医生将PST用作抑郁症治疗方法的决策的因素。它既认识到障碍，也认识到促进因素。这表明，对于许多全科医生来说，PST被视为一种积极的方法，这为那些寻求增加全科医生提供PST治疗的人提供了鼓励。通过识别一些潜在障碍以及解决其中许多障碍的相关选项，它提供了有助于规划全科医生PST培训的见解。
