Bibliotherapy as a Treatment for Depression in Primary Care.
J Clin Psychol Med Settings. 2010 Aug 28;
Authors: Naylor EV, Antonuccio DO, Litt M, Johnson GE, Spogen DR, Williams R, McCarthy C, Lu MM, Fiore DC, Higgins DL
This study was designed to determine whether a physician-delivered bibliotherapy prescription would compare favorably with the prevailing usual care treatment for depression in primary care (that often involves medication) and potentially offer an alternative. Six family physicians were trained to write and deliver prescriptions for cognitive-behavioral bibliotherapy. Thirty-eight patients were randomly assigned to receive either usual care or a behavioral prescription to read the self-help book, Feeling Good (Burns, D. D. (1999). Feeling good: The new mood therapy. New York: HarperCollins). The treatment groups did not differ in terms of overall outcome variables. Patients in both treatment groups reported statistically significant decreases in depression symptoms, decreases in dysfunctional attitudes, and increases in quality of life. Although not statistically significant, the mean net medical expenses in the behavioral prescription group were substantially less. This study provided empirical evidence that a behavioral prescription for Feeling Good may be as effective as standard care, which commonly involves an antidepressant prescription.
20803165
– Bibliotherapy as a Treatment for Depression in Primary Care.
Measuring organizational attributes in primary care: a validation study in Germany.
J Eval Clin Pract. 2010 Aug 19;
Authors: Ose D, Freund T, Kunz CU, Szecsenyi J, Natanzon I, Trieschmann J, Wensing M, Miksch A
Abstract Objective Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a translated and culturally adapted German version of the SOAPC. Methods The SOAPC was translated and culturally adapted according to established standards. The external validity of the German SOAPC was assessed using the German version of the Warr-Cook-Wall scale. A total of 200 practices randomly selected from a conference database were asked to participate in the validation study. Practice, clinicians and staff characteristics were determined via short-form questionnaires. We used standardized statistical procedures to reveal the psychometric properties of the SOAPC. Results A total of 54 practice teams participated by returning 297 completed questionnaires (297/425, response rate 69.8%). All four domains of the SOAPC (communication, decision making, stress/chaos, history of change) could be approved by factor analysis. Internal consistency is underlined by a Cronbach’s alpha of 0.70 or higher in all categories. We show strong correlation with the Warr-Cook-Wall scale in all corresponding categories indexing high external validity. Conclusions The German SOAPC is a reliable and valid instrument for the assessment of organizational attributes of practice teams as the providers of quality of care. Moreover, the tool makes it possible to map the state of implementation of quality management and practice organization. The availability of the German SOAPC encourages further research on this topic in German-speaking countries.
20727060
– Measuring organizational attributes in primary care: a validation study in Germany.
The pharmacological treatment of bipolar disorder in primary care.
Med J Aust. 2010 Aug 16;193(4):S24-30
Authors: Malhi GS, Adams D, Berk M
OBJECTIVE: To provide a practical overview of the pharmacological management of adults with bipolar disorder in primary care and the role of general practitioners in the pharmacotherapy of this complex disorder. DATA SOURCES: Published guidelines for the treatment of bipolar disorder, plus Cochrane reviews, meta-analyses, review articles and reports from randomised controlled trials that were published up to May 2009. STUDY SELECTION: Over 500 articles on the treatment of bipolar disorder were reviewed, with an emphasis on meta-analyses and systematic reviews of randomised controlled trials. Where evidence was more limited, open trials and non-controlled data were also reviewed. DATA EXTRACTION: Key recommendations relevant to GPs were synthesised and rated according to National Health and Medical Research Council levels of evidence. DATA SYNTHESIS: Lithium, valproate and atypical antipsychotics are first-line treatment options for acute mania, and monotherapy is ideal if it produces an adequate response. For depressive episodes, recommendations are less definitive and the use of antidepressants is controversial. Most patients require maintenance treatment, during which pharmacotherapy should be used to prevent relapse, and psychological and social interventions should be considered. CONCLUSIONS: Bipolar disorder is a lifelong episodic illness that affects 1%-2% of the population, many of whom are principally managed by their GPs. Pharmacological treatment with mood-stabilising agents is the primary form of management, although this is ideally provided in conjunction with psychosocial interventions.
20712557
– The pharmacological treatment of bipolar disorder in primary care.
