A nurse-coordinated educational initiative addressing primary care professionals' attitudes to and problem-solving in depression in older people--a pilot study.
This study assessed the feasibility and efficacy of an intervention focusing on primary care professionals' attitudes to, problem-solving in and practice relating to depression in old age before and after a nurse-implemented educational intervention. One hundred and twenty-one practices were approached, in which 297 doctors worked. Most practices did not want to be involved in this study. Evidence from previous studies and this one suggests that GPs are more amenable to interventions which are implemented by doctors rather than other health personnel. In addition, the lack of interest in this intervention may be a reflection of the therapeutic nihilism of primary care physicians regarding depression in older people. Sixteen surgeries expressed an interest in the study, of whom 14 participated in the study comprising 40 GPs. Thirty-one GPs and 24 nurses completed the baseline questionnaires. Only six GPs and no nurses returned completed questionnaires post-intervention. The only statistically significant before versus after change in the attitude questionnaire was found in 'I need more training to be able to deal effectively with depression in the elderly'. Mean scores were 0.73 and 0.47 respectively (p<0.05; 95%CI 3.2-47.1). Significant improvements post-intervention were, however, found in the answers to three questions (all p<0.05) addressing whether patients with depression complicated by or presenting with physical illness were referred appropriately and/or followed up. The results of our study do not indicate that the evaluation of nurse-led educational interventions in primary care is feasible in the field of depression in old age. The belief that all that is needed is the provision of accessible education of professionals by experts in the field to change attitudes and practice has not been reinforced. The high refusal rate suggests that such interventions are unlikely in any case to be generally acceptable.
Livingston
G
G
Department of Psychiatry and Behavioural Sciences, RFUCL Medical School, 48 Riding House Street, London W1N 8AA, UK. g.livingston@ucl.ac.uk
Yard
P
P
Beard
A
A
Katona
C
C
D000368:Aged / Q000523:psychology*; D001290:Attitude; D003863:Depression / Q000523:psychology*; D005851:Geriatric Nursing; D005852:Geriatric Psychiatry; D006299:Health Services for the Aged / Q000600:supply & distribution; D006801:Humans; D010353:Patient Education as Topic; D010865:Pilot Projects; D011320:Primary Health Care; D011340:Problem Solving; D011795:Surveys and Questionnaires