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Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations.
- Source :
- BJGP Open; Dec2019, Vol. 3 Issue 4, p1-11, 11p
- Publication Year :
- 2019
-
Abstract
- Background: Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them. Aim: To examine how GPs recommend antidepressants and talking therapy, and how patients respond. Design & setting: A total of 52 recorded primary care consultations for depression, anxiety, and stress were analysed. Method: Using a standardised coding scheme, five ways doctors recommend treatment were coded, conveying varying authority and endorsement. The treatment recommendation types were as follows: more directive pronouncements (I'll start you on X); proposals (How about we start X?); less directive suggestions (Would you like to try X?); offers (Do you want me to give you X?); and assertions (There are medications that might help). It was also coded whether patients accepted, passively resisted (for example, withholding response), or actively resisted (for example, I've tried that before). Results: A total of 33 recommendations occurred in 23 consultations. In two-thirds of cases, GPs treated the patient as primary decision-maker by using suggestions, offers, or assertions. In onethird of cases, they used more directive pronouncements or proposals. GPs endorsed treatment moderately (67%), weakly (18%), or strongly (15%). Only one-quarter of recommendations were accepted immediately. Patients cited fears about medication side effects and/or dependency, group therapy, and doubts about treatment efficacy. Despite three-quarters of patients resisting, 76% got prescriptions or self-referral information for talking therapy. Conclusion: Initially, GPs treat patients as the decision-maker. However, although patients resist, most end up with treatment. This may impact negatively on treatment uptake and success. Social prescribing may fill a treatment gap for some patients. how patients respond in recorded real-life consultations, this article shows that GPs overwhelmingly leave decisions about these treatments to patients. It also suggests that patients frequently resist such recommendations, sometimes explaining their reasons for doing so (concerns about dependence, efficacy, and so on). Patients who resisted typically ended up being given the treatments anyway. Analysis of cases where patients resist suggests discussing and providing information about treatment options before making a recommendation could improve patient acceptance and uptake. [ABSTRACT FROM AUTHOR]
- Subjects :
- ANTIDEPRESSANTS
MENTAL health
SOCIAL sciences
PRIMARY health care
FAMILY medicine
Subjects
Details
- Language :
- English
- ISSN :
- 23983795
- Volume :
- 3
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- BJGP Open
- Publication Type :
- Academic Journal
- Accession number :
- 141472458
- Full Text :
- https://doi.org/10.3399/bjgpopen19X101670