Diverse voices, simple desires: a conceptual design for primary care to respond to depression and related disorders.
BACKGROUND
The World Health Organization and the World Organization of Family Doctors have called for 'doable' and 'limited' tasks to integrate mental health into primary care. Little information is provided about tasks GPs can undertake outside of guidelines that suggest to prescribe medication and refer to specialists.


OBJECTIVE
The reorder study aimed to gather diverse patient and community perspectives to inform the development of an effective system of depression care.


METHODS
Five hundred and seventy-six patients completed computer-assisted telephone interviews. Two hundred and seventy-six community stakeholders completed a modified two round Delphi. Responses were analysed to identify tasks and these were synthesised into a conceptual design.


RESULTS
Fifteen core tasks were identified, 5 were agreed upon and a further 10 identified by each group but not agreed upon. Listen, understand and empathize, provide thorough and competent diagnosis and management, follow-up and monitor patients, be accessible and do not rush appointments and provide holistic approach and tailor care to individual needs were agreed on. Other tasks included: develop plans with patients, assess for severity and suicide risk, account for social factors, be well trained in depression care and offer a range of treatment options, appropriate and timely referral, support and reassurance, educate patients about depression, prescribe appropriately and manage medication and be positive and encouraging.


CONCLUSIONS
The tasks form the basis of a conceptual design for developing a primary care response to depression. They fit within three domains of care: the relational, competency and systems domains. This illustrates tasks for GPs beyond prescription and referral.
Palmer
Victoria
V
Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Victoria 3053, Australia. v.palmer@unimelb.edu.au
Gunn
Jane
J
Kokanovic
Renata
R
Griffiths
Frances
F
Shrimpton
Bradley
B
Hurworth
Rosalind
R
Herrman
Helen
H
Johnson
Caroline
C
Hegarty
Kelsey
K
Blashki
Grant
G
Butler
Ella
E
Johnston-Ata'ata
Kate
K
Dowrick
Christopher
C
D000328:Adult; D000368:Aged; D003697:Delphi Technique; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D014739:Victoria