TY - JOUR
T1 - Multiple barriers against successful care provision for depressed patients in general internal medicine in a Japanese rural hospital
T2 - A cross-sectional study
AU - Ohtsuki, Tsuyuka
AU - Inagaki, Masatoshi
AU - Oikawa, Yuetsu
AU - Saitoh, Akiyoshi
AU - Kurosawa, Mie
AU - Muramatsu, Kumiko
AU - Yamada, Mitsuhiko
N1 - Funding Information:
This work was supported by a grant for Research on Psychiatric and Neurological Diseases and Mental Health from the Ministry of Health, Labour and Welfare. We thank Ms. Asako Yoshida and Mr. Fumiji Takahashi for helping with patient interviews and Mr. Nobuo Nomura, Mr. Kazunori Yaegashi, Ms. Mieko Okudera, and Ms. Miyako Ishikawa for their kind support.
Funding Information:
This study was conducted on 6 of 10 consultation days between June 15 and 26, 2009, at a general internal medicine outpatient clinic in a general hospital having no mental health services. This hospital is located in Oshu City, Iwate Prefecture in the Tohoku region of Japan. The hospital is functioning as a regional public hospital and is funded by the National Health Insurance Society at Oshu City. Oshu City is a typical rural area about 500 km north of Tokyo with low influx and efflux of the population. There are high proportions of elderly people and people engaged in primary industry [12].
PY - 2010/4/26
Y1 - 2010/4/26
N2 - Background: A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital.Methods: Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ). Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records.Results: Among 312 patients, 27 (8.7%) and 52 (16.7%) were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8%) were recognized by physicians as having a mental disorder, but only three (11.1%) were diagnosed as having a mood disorder.Only two patients with major depressive disorder (7.4%) had been prescribed antidepressants. Even among those (n = 15) whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7%) were prescribed an antidepressant.Conclusions: Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring patients to mental health specialists.
AB - Background: A general internist has an important role in primary care, especially for the elderly in rural areas of Japan. Although effective intervention models for depressed patients in general practice and primary care settings have been developed in the US and UK medical systems, there is little information regarding even the recognition rate and prescription rate of psychotropic medication by general internists in Japan. The present study surveyed these data cross-sectionally in a general internal medicine outpatient clinic of a Japanese rural hospital.Methods: Patients were consecutively recruited and evaluated for major depressive disorder or any mood disorder using the Patient Health Questionnaire (PHQ). Physicians who were blinded to the results of the PHQ were asked to diagnose whether the patients had any mental disorders, and if so, whether they had mood disorders or not. Data regarding prescription of psychotropic medicines were collected from medical records.Results: Among 312 patients, 27 (8.7%) and 52 (16.7%) were identified with major depressive disorder and any mood disorder using the PHQ, respectively. Among those with major depressive disorder, 21 (77.8%) were recognized by physicians as having a mental disorder, but only three (11.1%) were diagnosed as having a mood disorder.Only two patients with major depressive disorder (7.4%) had been prescribed antidepressants. Even among those (n = 15) whom physicians diagnosed with a mood disorder irrespective of the PHQ results, only four (26.7%) were prescribed an antidepressant.Conclusions: Despite a high prevalence of depression, physicians did not often recognize depression in patients. In addition, most patients who were diagnosed by physicians as having a mood disorder were not prescribed antidepressants. Multiple barriers to providing appropriate care for depressed patients exist, such as recognizing depression, prescribing appropriate medications, and appropriately referring patients to mental health specialists.
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U2 - 10.1186/1471-244X-10-30
DO - 10.1186/1471-244X-10-30
M3 - Article
C2 - 20416116
AN - SCOPUS:77951214898
SN - 1471-244X
VL - 10
JO - BMC Psychiatry
JF - BMC Psychiatry
M1 - 30
ER -
