Depression during pregnancy: views on antidepressant use and information sources of general practitioners and pharmacists

Background  

The use of antidepressants during pregnancy has increased in recent years. In the Netherlands, almost 2% of all pregnant women are exposed to antidepressants. Although guidelines have been developed on considerations that should be taken into account, prescribing antidepressants during pregnancy is still a subject of debate. Physicians and pharmacists may have opposing views on using medication during pregnancy and may give contradictory advice on whether or not to take medication for depression and anxiety disorders during pregnancy. In this study, we investigated information sources used by general practitioners (GPs) and pharmacists and their common practices.     

Usage of information sources by general practitioners

Questionnaires were sent to approximately 500 general practioners in five areas of one National Health Service Region; there was a 52% response. Certain characteristics of each general practitioner, which were collected from the questionnaire and medical lists, were used to assess how information was used by different `types' of general practitioner. Generally, sources of information emanating from the pharmaceutical industry are used more to introduce the new product, while the `professional' sources such as medical journals are used more to evaluate it. Younger doctors used Drug and Therapeutics Bulletin more than did their colleagues, and single-practice doctors found the representative to be more useful than did joint-practice doctors.     

The role of psychological well-being in retaining rural general practitioners

OBJECTIVE: Retention of rural GPs is an increasing area of concern and is receiving considerable attention from the government, medical authorities and the media. This study aimed to examine the potential for psychological interventions to assist in the retention of rural GPs through targeting their psychological well-being. DESIGN: GPs completed a questionnaire, including questions about their level of support in rural practice, psychological health (work-related morale and distress, distress related specifically to working in rural general practice, quality of work life) and intentions to leave rural practice. SETTING: Rural general practices in South Australia. PARTICIPANTS: One hundred and eighty-seven rural GPs. RESULTS: Results indicated that rural GPs who were seriously considering leaving rural practice had higher work-related distress, higher distress related specifically to working in a rural general practice and lower quality of work life. GPs who considered leaving rural practice also reported having fewer colleagues with whom to discuss professional issues. CONCLUSION: Results indicated that psychological interventions (such as cognitive behavioural training), assistance with stress reduction and coping mechanisms (such as more interaction with colleagues) may be of benefit to GPs who are considering leaving rural practice. Such training may increase the number of GPs who ultimately stay in rural practice.     

The role of telematics in assisting family carers and frail older people at home

The overall aim of the ACTION research project (Assisting Carers using Telematic Interventions to meet Older person's Needs) is to maintain or enhance the autonomy, independence and quality of life of frail older and disabled people and their family carers by providing information, advice and support in the home. The authors report on the first phase of evaluation conducted using a case-study approach to test the ACTION system in several family carers' homes in Sheffield, England. The results reflect the realities of conducting an applied research technology project and are discussed with reference to the government's recent national strategy for carers. The authors acknowledge the need for further evaluation studies to explore the key issues raised within this preliminary evaluation phase.     

The role of family carers in the use of personal budgets by people with mental health problems

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012–2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health‐related social care needs. The sample was drawn from three sites across England, with additional carers being recruited via voluntary sector networks. Our findings show that for many people with severe mental health needs who lack motivation and confidence to negotiate access to personal budgets, carers may provide the necessary support to enable them to benefit from this form of social care support. We illustrate the role carers may play in initiating, pursuing and maximising the level of support available through personal budgets. However, some carers interviewed considered that personal budget funding was reduced because of practitioners’ assumptions about carers’ willingness and ability to provide support. We also report perceived tensions between family carers and practitioners around appropriate involvement in decision‐making. The study findings have implications for local authorities, practitioners and family carers in supporting the involvement of family carers in support for people with severe mental health problems.     

The role of marketing for GDPs (general dentist practitioners)

Dentists, while recognising the need to be more marketing orientated, still have some way to go to improve the perception of themselves and their services in the eyes of the public. Nigel Coates and John Willans suggest some ways to address the barriers to visiting dentists.     

Perceptions around concordance – focus groups and semi-structured interviews conducted with consumers, pharmacists and general practitioners

BACKGROUND: Achieving concordance by identifying beliefs about illness, treatment and medicine-taking should impact positively on behaviour and consumer satisfaction with respect to treatment, and health outcomes may be improved. OBJECTIVE: To explore, in the Australian context, beliefs and expectations of general practitioners (GPs), consumers and pharmacists in relation to concordance to allow further exploration of the implementation of principles of concordance in Australia. DESIGN: Qualitative analysis of focus group and semi-structured interview data. SETTING AND PARTICIPANTS: Focus groups were held with seven consumers and nine pharmacists and, in-depth, semi-structured interviews were held with 10 GPs between February and May 2003, in Brisbane (Australia). RESULTS: This explorative study identified a variety of issues. Consumers expressed the need for more input from health professionals - being given more information on their treatments and conditions, more time spent in discussion, and establishing a system where harmonious relationships between health professionals could take place, which would result in a more consumer-friendly health care system. The main issues voiced by the pharmacists were about the idea of organizing the health care system in a way that would accommodate more quality information sharing between all partners. GPs' issues included better and unlimited information-sharing, having more time to promote quality in health care and receiving remuneration for increased verbal contact with other health care professionals. Suggestions were made about ways to achieve concordance by improved information-sharing and shared decision-making. CONCLUSION: The data from this study will lead to the development of models to explore and attempt to incorporate principles of concordance in Australian pharmacy and medical practice.     

Patients with dementia and their carers in general practice

In 2004, 6.5% of Australians over 65 years of age were estimated to have dementia and the prevalence of dementia is rising as a result of our aging population. There is evidence to show that carer wellbeing is important for the wellbeing of the patient. Increasing burden of care may lead to depression, anxiety, and more frequent physical illness in the carer, and earlier institutionalisation of patients. The general practitioner's role includes recognising early dementia, undertaking assessments to confirm the diagnosis, managing the disease, health promotion and support for both patient and carer, and follow up. We initiated a project to explore the extent to which GPs currently fulfill this role for patients with dementia still living in the community (rather than in hostels or nursing homes).     

Intrauterine contraception: the role of general practitioners in four Dutch general practices

The intrauterine device (IUD) use in the Netherlands and the United States is limited to a small group of women, though the risk of infection and pregnancy is small. Therefore, it was of interest to investigate the characteristics of women who choose an IUD as contraceptive method and the influence of general practitioners concerning IUD insertion. The aim of this retrospective cohort study was to assess differences between general practices and to investigate the characteristics of IUD users. Also, we wished to study changes in IUD use with time. Patients were selected from four academic general practices belonging to the continuous morbidity registration project in Nijmegen, the Netherlands. The population under study included 461 women registered in the academic practices with a code for insertion of a new IUD in the period from 1981 to 2001. More than half of the women were between 25 and 34 years old at the time of insertion. Almost one quarter were nulliparous, one quarter unmarried and the distribution of socioeconomic status was the same as the entire practice population. General practitioners have clear preferences for certain types of IUD and, in particular, for not inserting an IUD in nulliparous women. In conclusion, married or cohabiting women, around 30 years of age, with children, are in the majority in receiving an IUD as contraception. General practitioners clearly follow their own opinions about inserting IUD in nulliparous women. Currently, general practitioners are prescribing more Multiload Cu 375 IUDs and levonorgestrel-releasing IUDs.     

The medication role of informal carers

A qualitative study was undertaken to determine the role that informal carers perform with respect to dependants' medication. The objectives of the study were to understand the nature of medication-related assistance provided by informal carers and to identify any problems they encounter with this role. Face-to-face interviews were conducted with 20 informal carers who were known to provide medication-related assistance. Three group discussions were held with informal carers attending a local selfhelp group. Results from the study indicate that informal carers often provide support with all aspects of medication management including obtaining supplies, administering medication and monitoring effects. Other informal carers keep an eye on their dependant's medication but are not involved in the day-to-day management. The amount of support provided is influenced by the carer's and dependant's physical and mental ability. Furthermore, carers' commitments, such as family and work, and their relationship with the dependant will also affect the level of support they provide. A lack of medication-related knowledge, and an inability to access some of the pharmaceutical and medical services available, result in carers experiencing additional difficulties in fulfilling their role. More attention should be paid to the practicalities of managing medication. Furthermore, the needs of carers should be considered alongside those of the patient when developing pharmaceutical services. Such a philosophy would be in line with the provision of Community Care which advocates the development of services which are sensitive to carers as well as to dependants.     

Main goals of the activities of family physicians and general practitioners]

The activity of a new category of general practitioners and their role in the delivery of medical care for the population are analysed. The functional structure of the computer system for information supply of family doctor is considered. The flow chart of a unified primary information document of the given automated system is presented.     

Changes in the role of general practitioners in child health surveillance

Background: Changes in their Contract in 1990 gave general practitioners the opportunity to become more involved in child health surveillance. This study aimed to describe and compare child health surveillance services provided by general practitioners before and after the changes of the 1990 GP contract.Methods: A questionnaire was sent to all general practices within the Nottingham Health Authority area in 1990, and this process was repeated in 1994, ascertaining the services provided for child health surveillance. Outcome measures were: the reported provision of services, keeping of records and facilities for following up non-attenders. Also recorded were the training and qualifications of general practitioners and their attitudes towards child health surveillance.Results: Response rates were 62% in 1990 and 80% in 1994. More practices were involved in the provision of child health surveillance services in 1994, more held a baby clinic and more reported having a recall system for non-attenders. There was little change in the training or qualifications of GPs in child health between 1990 and 1994. In 1994, there was evidence of GPs meeting regularly with Health Visitors. There remained a small number of practices who were not interested in child health surveillance.Conclusion: The 1990 GP contract appears to have increased the provision of child health surveillance services by GPs and improved liaison with Health Visitors in general practice.     

Ethnic disparities in vaccine safety attitudes and perceptions of family doctors/general practitioners

Ethnic groups have disparate perceptions of and experiences with family doctors/General Practitioners (GP), yet little is known about differences in GP influence on vaccine safety perceptions across ethnic groups in New Zealand. Using data from the 2017 New Zealand Attitudes and Values Study survey (N = 17,072), the current study investigates the correlation between vaccine safety agreement and GP satisfaction, perceived GP cultural similarity, GP cultural respect, healthcare access and diverse demographic factors among Māori, Pacific, Asian and European New Zealanders. Europeans expressed greater positive perceptions of GPs and high vaccine safety agreement (74.7%) relative to other ethnic groups (Asian: 72.3%; Pacific: 65.8%; Māori: 59.4%). Increased GP satisfaction, healthcare access and education were key correlates of higher vaccine safety agreement among Europeans. Increased GP satisfaction, healthcare access and being non-religious were key correlates among Māori. Higher vaccine safety agreement was significantly and strongly associated with being non-religious, born overseas and having a partner among Pacific peoples. Among Asian peoples, men, younger, more educated individuals, and those with greater perceived GP cultural respect showed higher agreement. Our findings highlight important ethnic differences in the shaping of vaccine attitudes and inform the development of tailored interventions for specific ethnic groups.