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Evaluation of ICD-10 PHC mental health guidelines in detecting and managing depression within primary care

Published online by Cambridge University Press:  03 January 2018

Mark W. M. Upton ,
Maggie Evans ,
David P. Goldberg  and
Deborah J. Sharp
Mark W. M. Upton*
Affiliation:
Division of Psychiatry, University of Bristol
Maggie Evans
Affiliation:
Division of Primary Care, University of Bristol
David P. Goldberg
Affiliation:
Institute of Psychiatry, London
Deborah J. Sharp
Affiliation:
Division of Primary Care, University of Bristol
*
Dr Mark Upton, Burden Neurological Hospital, Stoke Lane, Stapleton, Bristol BS15 1QT
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Abstract

Background

The prevalence of mental disorders in the community is high, yet many remain unrecognised, misdiagnosed or poorly managed within primary care. Hence, guidelines for diagnosing and managing mental disorders in primary care, ICD–10 PHC, have been developed.

Aims

To introduce the guidelines into primary care and to assess whether they improve recognition, accuracy of diagnosis and treatment standards.

Method

GPs recorded information on all patients presenting with mental disorders before and after guidelines were introduced. A10% sample of patients underwent interviews to establish a formal diagnosis. Recognition of mental disorders was assessed by screening of patients attending their GP.

Results

The guidelines had no impact on the overall detection of mental disorders, the accuracy of diagnosis or the prescription of antidepressants. There was a significant increase in the number of patients diagnosed with depression or unexplained somatic symptoms. The GPs also made increased use of psychological interventions.

Conclusions

The success of the guidelines in bringing about change is by no means certain. Some areas appeared more susceptible to change than others.

Type
Papers
Information
The British Journal of Psychiatry , Volume 175 , Issue 5 , November 1999 , pp. 476 - 482
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

†

See invited commentaries, p. 483, this issue.

Declaration of interest

Funding was provided by the Department of Health.

References

Baker, R. (1990) The development of a questionnaire to assess patients' satisfaction with consultations in general practice. British Journal of General Practice, 40, 487–490.Google Scholar
Brugha, T. S. & Cragg, D. (1990) The List of Threatening Experiences: the reliability and validity of a brief life event questionnaire. Acta Psychiatrien Scandinavica, 82, 77–81.Google Scholar
Donoghue, J. M. & Tylee, A. (1996) The treatment of depression: prescribing patterns of antidepressants in primary care in the UK. British Journal of Psychiatry, 168, 164–168.Google Scholar
Dowrick, C. & Buchan, I. (1995) Twelve month outcome of depression in general practice: does detection or disclosure make a difference? British Medical Journal, 311, 1274–1276.CrossRefGoogle ScholarPubMed
Freeling, P., Rao, B. M., Paykel, E. S., et al (1985) Unrecognised depression in general practice. British Medical Journal. 290, 1880–1883.Google Scholar
Goldbarg, D. & Williams, P. (1988) A User's Guide to the General Health Questionnaire. Windsor: NFER–Nelson.Google Scholar
Goldbarg, D. & Huxley, P. (1992) Common Mental Disorders. London: Routledge.Google Scholar
Goldbarg, D., Sharp, D. & Nanayakkara, K. (1995) The field trial of the mental disorders section of ICD–10 designed for primary care (ICD–10 PHC) in England. Family Practice, 12, 466–473.Google Scholar
Grol, R., Dalhuijsen, J., Thomas, S., et al (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. British Medical Journal. 317, 858–861.Google Scholar
Hodkinson, M. (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and Ageing, 1, 233–238.Google Scholar
Hotopf, M., Lewis, G. & Normand, C. (1996) Are SSRIs a cost-effective alternative to tricyclics? British Journal of Psychiatry, 168, 404–409.Google Scholar
Lewis, G., Pelosi, A. J., Araya, R. C., et al (1992) Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychological Medicine, 22, 465–486.Google Scholar
Lewis, G., Sharp, D., Bartholomew, J., et al (1996) Computerised assessment of common mental disorders in primary care: effect on clinical outcome. Family Practice, 13, 120–126.CrossRefGoogle ScholarPubMed
McCormick, A., Fleming, D. & Charlton, J. (1995) Morbidity Statistics from General Practice – Fourth National Study 1991–1992. OPCS series MB5 no. 3. London: HMSO.Google Scholar
Meitzer, H., Gill, B., Pettickrew, M., et al (1996) OPCS Surveys of Psychiatric Morbidity Report I: The Prevalence of Psychiatric Morbidity among Adults living in Private Households. London: HMSO.Google Scholar
Ormel, J., Koeter, M. W. J., van den Brink, W., et al (1991) Recognition, management, and course of anxiety and depression in general practice. Archives of General Psychiatry. 48, 700–706.Google Scholar
Paykel, E. S. & Priest, R. G. (1992) Recognition and management of depression in general practice: consensus statement. British Medical Journal, 305, 1198–1202.Google Scholar
Ustun, T. B., Goldberg, D., Cooper, J., et al (1995) New classification for mental disorders with management guidelines for use in primary care: ICD–10 PHC chapter five. British Journal of General Practice, 45, 211–215.Google Scholar
Wing, J. K., Nixon, J., Mann, S. A., et al (1977) Reliability of PSE used in a population survey. Psychological Mediane, 7, 505–516.Google Scholar
World Health Organization (1992) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10). Geneva: WHO.Google Scholar
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