Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial
Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial
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DOI：
10.1017/s0033291704002764
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发表时间：
2005-01-01
影响因子：
6.9
通讯作者：
Sartorius, N
中科院分区：
文献类型：
--
作者：
Levav, I;Kohn, R;Sartorius, N
背景为了改善对抑郁症患者的护理，减轻抑郁症日益加重的负担，世界卫生组织美洲区域办事处发起了一项重大的区域性倡议。这项工作的一个核心部分是针对初级保健系统，在许多国家，对抑郁症的诊断和治疗是不足的。本研究通过测量初级保健医生知识、态度和实践（KAP）的变化，评估了世界精神病学协会在初级保健医生抑郁症培训项目中开发的材料。来自五个拉丁美洲国家的107名医生和6174名患者参加了试验。分别于培训前1个月和培训后1个月进行KAP测评。此外，使用Zung抑郁量表和DSM-IV/ICD-10重性抑郁检查表，在两个时间段的典型一周内对就诊患者的抑郁症状进行测量。该计划略微提高了对抑郁症的认识，并改变了一些态度，但对实际做法的影响有限。没有证据表明抑郁症的诊断更频繁，也没有改善精神药理学管理。医生诊断和基于患者自我报告的诊断之间的培训后协议仍然很低。然而，医生似乎更有信心在培训后治疗抑郁症患者，并介绍了更少的患者精神科医生。传统的培训手段，初级保健医生在抑郁症的临床实践几乎没有影响，无论教学材料的质量。
Background. In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP).Method. One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ICD-10 major depression checklist.Results. The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists.Conclusions. Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.