Do longer consultations improve the management of psychological problems in general practice? A systematic literature review
Do longer consultations improve the management of psychological problems in general practice? A systematic literature review
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DOI：
10.1186/1472-6963-7-71
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发表时间：
2007-05-17
影响因子：
2.8
通讯作者：
Gunn, Jane
中科院分区：
文献类型：
--
作者：
Hutton, Catherine;Gunn, Jane
背景：心理问题在我们的社区中是一个巨大的疾病负担，而全科医生是主要的护理提供者。有证据表明，延长全科医生的会诊时间与提高护理质量有关；但是，这需要与以下事实相平衡：医生的时间是一种有限的资源，更长时间的咨询可能导致获得卫生保健的机会减少。本研究的目的是进行一项系统的文献综述，以确定全科医生对心理问题的管理是否与增加咨询时间有关，并探讨更长时间的咨询是否与心理问题患者更好的健康结果有关。方法：检索截至2006年6月7日的Medline （Ovid）数据库。使用以下搜索词：全科医生或初级卫生保健（自由文本）或家庭医生（MeSH）和咨询时间或持续时间（自由文本）或时间因素（MeSH）和抑郁或心理问题或抑郁（自由文本）。在Web of Science、Pubmed、b谷歌Scholar和Cochrane Library进行了类似的搜索，没有发现其他论文。如果研究包含比较咨询时间和在普通医疗机构或初级卫生保健机构中对心理问题的管理或发现的数据，则纳入研究。阅读了这些研究报告并制定了分类，以便能够系统地提取和综合数据。结果：29篇论文符合纳入标准。据报道，有心理问题诊断记录的咨询时间比没有心理诊断记录的咨询时间长。目前尚不清楚这是否与额外的时间或咨询方式有关。全科医生报告说，时间压力是治疗抑郁症的主要障碍。有一些证据表明，增加咨询时间与更准确地诊断心理问题有关。结论：需要进一步的研究来阐明问诊时间越长，心理问题检出率越高的相关因素，并确定心理问题检出率与全科医生的态度、性别、年龄或培训以及患者的年龄、性别和社会经济地位之间的关系。如果一般做法是更有效地处理有心理问题的人，这些都是重要的考虑因素。
Background: Psychological problems present a huge burden of illness in our community and GPs are the main providers of care. There is evidence that longer consultations in general practice are associated with improved quality of care; but this needs to be balanced against the fact that doctor time is a limited resource and longer consultations may lead to reduced access to health care.The aim of this research was to conduct a systematic literature review to determine whether management of psychological problems in general practice is associated with an increased consultation length and to explore whether longer consultations are associated with better health outcomes for patients with psychological problems.Methods: A search was conducted on Medline ( Ovid) databases up to7 June 2006. The following search terms, were used:general practice or primary health care ( free text) or family practice ( MeSH)AND consultation length or duration ( free text) or time factors ( MeSH)AND depression or psychological problems or depressed ( free text).A similar search was done in Web of Science, Pubmed, Google Scholar, and Cochrane Library and no other papers were found.Studies were included if they contained data comparing consultation length and management or detection of psychological problems in a general practice or primary health care setting. The studies were read and categories developed to enable systematic data extraction and synthesis.Results: 29 papers met the inclusion criteria. Consultations with a recorded diagnosis of a psychological problem were reported to be longer than those with no recorded psychological diagnosis. It is not clear if this is related to the extra time or the consultation style. GPs reported that time pressure is a major barrier to treating depression. There was some evidence that increased consultation length is associated with more accurate diagnosis of psychological problems.Conclusion: Further research is needed to elucidate the factors in longer consultations that are associated with greater detection of psychological problems, and to determine the association between the detection of psychological problems and the attitude, gender, age or training of the GP and the age, gender and socioeconomic status of the patient. These are important considerations if general practice is to deal more effectively with people with psychological problems.