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      • HARVEST
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      Family physicians' responses to depression and anxiety in Saskatchewan family practice

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      Kosteniuk_Dissertation.pdf (5.140Mb)
      Date
      2009-09
      Author
      Kosteniuk, Julie
      Type
      Thesis
      Degree Level
      Doctoral
      Metadata
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      Abstract
      The current maxim concerning diagnosis and treatment of mood and anxiety disorders is that family physicians fail to appropriately respond to patients with anxiety and depression. This estimate is based upon a collection of studies that have found that accurate recognition in general practice occurred in 9% to 75% of patients with depression, and 34% to 50% of patients with anxiety. However, most studies have found that more than half of physicians accurately detected depression and anxiety in their patients. This dissertation examined physicians’ responses (detection, treatment, and follow-up) to clinical scenarios of patients presenting with symptoms of either depression or anxiety. Furthermore, this study evaluated the associations between physicians’ responses and physician attributes (personal and professional), organizational setting, information/resource use, and barriers to care. A cross-sectional study of Saskatchewan family physicians yielded a response rate of 49.7% (N=331/666). The results of this study revealed that most physicians provided appropriate depression and anxiety care with respect to recognition of disorders and follow-up care. Specifically, 85.4% of physicians provided an accurate tentative diagnosis of depression, and 86.3% provided an accurate tentative diagnosis of anxiety; 82.5% of physicians suggested adequate follow-up depression care while 79.4% offered adequate follow-up anxiety care. However, a notable proportion of physicians did not provide effective treatment; 65.6% of physicians recommended effective (immediate) anxiety treatment, and 55.6% recommended effective (immediate) depression treatment. This study found that physicians’ provision of care to patients with anxiety and depression was more likely to be associated with their personal attributes, organizational setting, and information/resource use than with their professional attributes. First, neither tentative diagnosis of depression nor tentative diagnosis of anxiety was significiantly associated with any of the tested measures. Second, ineffective treatment of depression was significantly more likely among physicians who were female, educated at the undergraduate level in Canada (versus elsewhere), scored lower on anxiety attitude factor 1 (social context view of anxiety amenable to intervention), had a low patient load (< 100 patients/week), and used medical textbooks to make specific clinical decisions; ineffective treatment of anxiety was significantly more likely among physicians who had completed their undergraduate and postgraduate medical training in Canada (versus elsewhere), had a low patient load (
      Degree
      Doctor of Philosophy (Ph.D.)
      Department
      Psychiatry
      Program
      Psychiatry
      Supervisor
      D'Arcy, Carl
      Committee
      Mousseau, Darrell; Bland, Roger; Tempier, Raymond; Shah, Syed; Morgan, Debra
      Copyright Date
      September 2009
      URI
      http://hdl.handle.net/10388/etd-09162009-151334
      Subject
      diagnosis
      physicians
      anxiety
      depression
      treatment
      follow-up
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