Dumesnil Hélène, Apostolidis Thémis, Verger Pierre
Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France.
PLoS One. 2018 Jan 31;13(1):e0190565. doi: 10.1371/journal.pone.0190565. eCollection 2018.
French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates.
This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression.
In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content.
We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists.
Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area.
法国全科医生（GP）将重度抑郁症患者转介给精神科医生或进行心理治疗的比例特别低。
这项定性研究旨在探讨全科医生对心理治疗的看法、他们与心理健康专业人员的关系、他们对自身以及精神科医生在治疗抑郁症中角色的认知，以及这些因素与全科医生管理抑郁症策略之间的关系。
2011年，对法国东南部32名执业全科医生进行了基于半结构化访谈指南的深入访谈。通过分析逐字记录的主题内容进行研究。
根据他们对抑郁症治疗策略的看法和实践，我们确定了三类医生：支持药物治疗、支持心理治疗以及实践方式混合的医生。大多数参与者认为他们与精神科医生的关系不令人满意，希望与他们有更多更好的合作，并在全科医疗中有相同的管理理念。这个理念既基于全科医生共同的实践价值观和原则，也基于他们将自己的管理实践与精神科医生的实践明确区分开来。
全科医生共有的几种态度和价值观可能导致法国心理治疗转介率低：强烈的职业认同感、全科医生在抑郁症治疗策略上的态度和实践存在很大差异、有时对精神科医生的看法不利。培养共同文化以及改善全科医生与精神科医生之间合作的行动至关重要。这些行动包括协作护理体系以及为同一地区执业的全科医生和精神科医生开展跨学科培训。
