Williams J W, Bhogte M, Flinn J F
South Texas Veterans Health Care System, San Antonio, USA.
Int J Psychiatry Med. 1998;28(1):123-36. doi: 10.2190/6KC4-HB1M-0XD3-W5EF.
The purpose of this article is to identify literature-based content for the design of educational programs on depression for practicing primary care physicians.
A MEDLINE search was conducted of English-language medical literature published from 1982 through July 1997 for studies describing primary care physicians' knowledge, skills, practice patterns, and perceived barriers related to care of depressed patients. Studies focusing exclusively on residency training and those describing physician practices outside North America were excluded. Of 377 articles identified, forty met inclusion and exclusion criteria.
Recommendations for educational content were identified from the literature review. For recognition, educators should prioritize communication skills and strategies for the use of depression questionnaires. For diagnosis, practice interpreting symptoms in the medically ill, strategies for efficient diagnosis, and systematic approaches to assessing suicide risk should be emphasized. For treatment, greater attention to the therapeutic alliance, staged therapy, and strategies for improving medication adherence are indicated.
There is a moderately well developed literature describing self-perceived and observed gaps in the current care for depression in primary care. Addressing the entire list of needs would take more time than practicing physicians are likely to have. An important challenge for educators is to design flexible programs based on individualized needs assessment or, when not possible, to prioritize the most generalizable needs.
本文旨在为面向执业初级保健医生的抑郁症教育项目设计确定基于文献的内容。
对1982年至1997年7月发表的英文医学文献进行了MEDLINE检索，以查找描述初级保健医生与抑郁症患者护理相关的知识、技能、实践模式及感知障碍的研究。仅关注住院医师培训的研究以及描述北美以外地区医生实践的研究被排除。在确定的377篇文章中，有40篇符合纳入和排除标准。
通过文献综述确定了教育内容的建议。在识别方面，教育工作者应优先关注沟通技巧以及使用抑郁症调查问卷的策略。在诊断方面，应强调练习解读内科疾病患者的症状、高效诊断策略以及评估自杀风险的系统方法。在治疗方面，需要更加关注治疗联盟、分阶段治疗以及提高药物依从性的策略。
有相当完善的文献描述了初级保健中当前抑郁症护理中自我感知和观察到的差距。满足所有需求所需的时间可能超过执业医生所能拥有的时间。教育工作者面临的一项重要挑战是根据个性化需求评估设计灵活的项目，或者在无法做到时，优先满足最具普遍性的需求。
