Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany.
BMC Health Serv Res. 2022 Oct 24;22(1):1279. doi: 10.1186/s12913-022-08631-w.
Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision.
Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed.
Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15-10.59; p < 0.001).
This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.
抑郁症是全球最常见的精神健康负担。初级保健医生（PCP）在为抑郁症患者提供护理方面发挥着关键作用。本研究的首要目标是检查初级保健中抑郁症的医疗保健状况，重点是 PCP 与心理健康专家之间的合作。其次，我们旨在研究德国单相抑郁症 S3 指南在初级保健中的作用。
对横断面在线调查的 75 名 PCP 数据进行了分析。对初级保健现状和抑郁症的描述性信息进行了分析。进一步，为了检查与使用指南相关的因素，进行了多元回归分析。
只有 22.1%的 PCP 认为与门诊心理健康专家合作的质量良好。合作中最常见的问题是结构性问题（49.3%，长等待名单，治疗单位少，以及沟通和信息交流中的障碍）。关于指南的作用，65%的 PCP 报告从未或很少使用过该指南，31.7%的 PCP 认为该指南根本没有用。此外，指南的感知有用性与指南的使用呈正相关。逻辑回归的结果显示，使用德国单相抑郁症 S3 指南与对指南感知有用性的评分之间存在显著关联（OR：4.771；95%CI：2.15-10.59；p<0.001）。
本研究强调了 PCP 的核心作用，并展示了在抑郁症的门诊医疗保健提供方面存在的主要障碍。现有研究结果表明，迫切需要协作式医疗保健模式来解决由于精神卫生保健系统碎片化而产生的障碍。最后，报告的德国单相抑郁症 S3 指南实施过程中的感知障碍表明，需要让 PCP 参与到循证指南的制定中，以确保指南在临床实践中的成功实施和使用。
