DMP Depression? The Family Practitioner’s Perspective
DOI: 10.3238/zfa.2012.0210-0217german translation / full article
Background: Currently a disease management program (DMP) for psychiatric disorders does not exist in Germany. Only a variety of model projects of integrated care (IV) exist on a regional level. The practicability of guideline implementation as part of a possible DMP for depression in Germany has been evaluated only for small groups of highly motivated doctors. The results were positive.
Objective: To examine the experiences of an unselected group of family practitioners (FPs) with existing DMPs, their attitudes and expectations toward a possible DMP depression, their knowledge and approach when dealing with depression and their view on practised cooperation with specialists. From the results, conclusions will be drawn for the planning of a future DMP.
Methods: In August 2011 all FPs in the city and rural district of Oldenburg and 27 randomly selected FPs of the adjacent rural district of Ammerland were asked to participate in a survey.
Results: Response rate was 78%. 10% of participants did not take part in any of the existing DMPs. 89% participated in two or more DMPs. 36% valued their experiences with running DMPs as positive, 27% negative and 37% neutral. The introduction of a DMP depression was welcomed by 23% whereas 61% were unwilling to participate. 61% advocated a transfer of doctor’s therapeutic competence to non-physician case managers and argued that they could not cope with the demand of time when participating in a DMP. Only 17% rejected a transfer of physician competence to nurses. 34% estimated their knowledge in treating depression as satisfactory, 40% as unsatisfactory. 47% were not aware of an S3-guideline depression. Cooperation with psychiatrists was unsatisfactory for 32% and with psychologists for 47%.
Conclusions: FPs can be divided in two groups: One is willing to participate as potential case managers whereas the other prefers to refer and coordinate only on a limited scale. The majority rejects involvement in a time consuming DMP including intensive training. The current approach of FPs to depression is far from utilising guidelines and cannot be changed by short term training interventions. For a nationwide implementation of a DMP it will be necessary to form case management teams following the British and Australian example. Planners should keep in mind that any new DMP is competing with existing ones and other quality management programs. A DMP could be successful as long as it does not interfere too much with FPs’ routine care and takes into account long standing coercions in the primary care system.