PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
 
Br J Gen Pract. 1998 January; 48(426): 899–902.
PMCID: PMC1409917

Can GPs audit their ability to detect psychological distress? One approach and some unresolved issues.

Abstract

BACKGROUND: General practitioners (GPs) should be able to detect psychological distress in their patients. However, there is much evidence of underperformance in this area. The principle of clinical audit is the identification of underperformance and amelioration of its causes, but there appear to be few evaluated models of audit in this area of clinical practice. AIM: To evaluate the feasibility of auditing GPs' performance as detectors of psychological distress. Specific objectives were to test a model of the audit cycle in the detection of psychological distress by GPs; to research GP perceptions of prior audit activity in this area and the validity of the instruments used to measure GP performance; and to research GP perceptions of the value of this specific approach to the audit of their performance and the particular value of different aspects of the model in terms of its impact on clinician behaviour. METHOD: Prospective controlled study of an audit cycle of GP detection of psychological distress. Nineteen GP principals used a self-directed educational intervention involving measurement of their performance, followed by data feedback and review of selected videotaped consultations. Qualitative data on GP views of audit in this area of clinical activity were collected before and after the quantitative data collection. RESULTS: The study shows that the GP cohort had not previously considered auditing their performance as detectors of psychological distress. They found the instruments of measurement and the model of audit acceptable. However, they also suggested modifications that might be educationally more effective and make the audit more practical. These included smaller patient numbers and more peer contact. The implications of the study for a definitive model of audit in this area are discussed. CONCLUSION: Effective audit of GP performance in detection of psychological distress is possible using validated instruments, and GP performance can be improved by educational intervention. GPs in this study appear more motivated by individual case studies and reflection through video analysis on undiagnosed patients than by quantitative data feedback on their performance. This study therefore supports other evidence that clinical audit has most impact when quantitative data is coupled with clinical examples derived from patient review.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (813K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Goldberg DP, Blackwell B. Psychiatric illness in general practice. A detailed study using a new method of case identification. Br Med J. 1970 May 23;1(5707):439–443. [PMC free article] [PubMed]
  • Marks JN, Goldberg DP, Hillier VF. Determinants of the ability of general practitioners to detect psychiatric illness. Psychol Med. 1979 May;9(2):337–353. [PubMed]
  • Ormel J, Koeter MW, van den Brink W, van de Willige G. Recognition, management, and course of anxiety and depression in general practice. Arch Gen Psychiatry. 1991 Aug;48(8):700–706. [PubMed]
  • Wright AF. Psychological distress: outcome and consultation rates in one general practice. J R Coll Gen Pract. 1988 Dec;38(317):542–545. [PMC free article] [PubMed]
  • Ormel J, Van Den Brink W, Koeter MW, Giel R, Van Der Meer K, Van De Willige G, Wilmink FW. Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study. Psychol Med. 1990 Nov;20(4):909–923. [PubMed]
  • Creed F, Gowrisunkur J, Russell E, Kincey J. General practitioner referral rates to district psychiatry and psychology services. Br J Gen Pract. 1990 Nov;40(340):450–454. [PMC free article] [PubMed]
  • Gask L, McGrath G, Goldberg D, Millar T. Improving the psychiatric skills of established general practitioners: evaluation of group teaching. Med Educ. 1987 Jul;21(4):362–368. [PubMed]
  • Gask L, Goldberg D, Lesser AL, Millar T. Improving the psychiatric skills of the general practice trainee: an evaluation of a group training course. Med Educ. 1988 Mar;22(2):132–138. [PubMed]
  • Whewell PJ, Gore VA, Leach C. Training general practitioners to improve their recognition of emotional disturbance in the consultation. J R Coll Gen Pract. 1988 Jun;38(311):259–262. [PMC free article] [PubMed]
  • Howe A. Detecting psychological distress: can general practitioners improve their own performance? Br J Gen Pract. 1996 Jul;46(408):407–410. [PMC free article] [PubMed]
  • Hopton JL, Howie JG, Porter AM. The need for another look at the patient in general practice satisfaction surveys. Fam Pract. 1993 Mar;10(1):82–87. [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]
  • Webb SJ, Dowell AC, Heywood P. Survey of general practice audit in Leeds. BMJ. 1991 Feb 16;302(6773):390–392. [PMC free article] [PubMed]
  • Black N, Thompson E. Obstacles to medical audit: British doctors speak. Soc Sci Med. 1993 Apr;36(7):849–856. [PubMed]
  • Grol R. National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards. Br J Gen Pract. 1990 Sep;40(338):361–364. [PMC free article] [PubMed]
  • al-Shehri A, Stanley I, Thomas P. Continuing education for general practice. 2. Systematic learning from experience. Br J Gen Pract. 1993 Jun;43(371):249–253. [PMC free article] [PubMed]
  • Coyne JC, Schwenk TL, Fechner-Bates S. Nondetection of depression by primary care physicians reconsidered. Gen Hosp Psychiatry. 1995 Jan;17(1):3–12. [PubMed]
  • Johnstone A, Goldberg D. Psychiatric screening in general practice. A controlled trial. Lancet. 1976 Mar 20;1(7960):605–608. [PubMed]
  • Brody DS, Lerman CE, Wolfson HG, Caputo GC. Improvement in physicians' counseling of patients with mental health problems. Arch Intern Med. 1990 May;150(5):993–998. [PubMed]
  • Hoeper EW, Nycz GR, Kessler LG, Burke JD, Jr, Pierce WE. The usefulness of screening for mental illness. Lancet. 1984 Jan 7;1(8367):33–35. [PubMed]
  • Rand EH, Badger LW, Coggins DR. Toward a resolution of contradictions. Utility of feedback from the GHQ. Gen Hosp Psychiatry. 1988 May;10(3):189–196. [PubMed]
  • Verhaak PF, Wennink HJ, Tijhuis MA. The importance of the GHQ in general practice. Fam Pract. 1990 Dec;7(4):319–324. [PubMed]
  • Dowrick C, Buchan I. Twelve month outcome of depression in general practice: does detection or disclosure make a difference? BMJ. 1995 Nov 11;311(7015):1274–1276. [PMC free article] [PubMed]
  • Shaw CD. Criterion based audit. BMJ. 1990 Mar 10;300(6725):649–651. [PMC free article] [PubMed]
  • Crossley D, Myres MP, Wilkinson G. Assessment of psychological care in general practice. BMJ. 1992 Nov 28;305(6865):1333–1336. [PMC free article] [PubMed]
  • Grol R. Quality improvement by peer review in primary care: a practical guide. Qual Health Care. 1994 Sep;3(3):147–152. [PMC free article] [PubMed]
  • Howe Amanda. Testing for depression. Br J Gen Pract. 1994 Aug;44(385):b378–378. [PMC free article]
  • Howe A. "I know what to do, but it's not possible to do it"--general practitioners' perceptions of their ability to detect psychological distress. Fam Pract. 1996 Apr;13(2):127–132. [PubMed]
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners