767 A Survey Of Management Of Depressive Patients In Gp's Practice: Practitioners Opinion

Objective: To describe actual management of depressed patients in primary care in order to improve current French recommendations.
Method: Qualitative study done from GPs' forum discussions. Participants filled a "Depression Attitude Questionnaire" (DAQ) in order to document their attitude with their depressive patients prior to discussion. Meeting"s rules were predefined and controlled by an independent moderator to ensure a standardized recording of answers along all sessions with parallel independent standardized minutes. A centralized analysis of all minutes was conducted until saturation of items.
Results: 504 GPs did participate. 84 meetings across all French regions were set up in 2006. The DAQ questionnaire responses have shown a strong heterogeneity of GPs' management of depression.
Diagnostic procedures for depression included a record of clinical symptoms matching with the DSM IV criteria but were not standardized in daily practice. Validated rating scales for severity assessment (MADRS, Hamilton, Beck) were rarely used (16%). Patients non verbal communication and pain as the prior features of their relationship were the leading factors for them to establish both diagnosis and treatment strategies.
GP's underlined that patients handling is part of their responsibilities in primary care. Coordination with psychiatrists was globally difficult to set up.
Conclusion: Treatment strategy of depression in primary care is not lead by guidelines. Diagnostic and patients follow up procedures have to be reinforced in order to improve quality of care. A better exchange of information between GPs and psychiatrists is of key importance for improving management of depressive patients.
A survey of management of depressive patients in GP's practice: practitioners opinion