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Research

Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations

Joseph Ford, Felicity Thomas, Richard Byng and Rose McCabe
BJGP Open 2019; 3 (4): bjgpopen19X101670. DOI: https://doi.org/10.3399/bjgpopen19X101670
Joseph Ford
1 Postdoctoral Research Associate, College of Medicine and Health, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
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  • For correspondence: j.w.ford@exeter.ac.uk
Felicity Thomas
2 Senior Research Fellow, College of Medicine and Health, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
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Richard Byng
3 Professor of Primary Care Research, Community and Primary Care Research Group, University of Plymouth, Faculty of Medicine and Dentistry, Plymouth Science Park, Plymouth, UK
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Rose McCabe
4 Professor of Clinical Communication, School of Health Sciences, City, University of London, London, UK
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Abstract

Background Patient take-up and adherence to antidepressants and talking therapy is low. However, little is known about how GPs recommend these treatments and whether patients accept them.

Aim To examine how GPs recommend antidepressants and talking therapy, and how patients respond.

Design & setting A total of 52 recorded primary care consultations for depression, anxiety, and stress were analysed.

Method Using a standardised coding scheme, five ways doctors recommend treatment were coded, conveying varying authority and endorsement. The treatment recommendation types were as follows: more directive pronouncements (I’ll start you on X); proposals (How about we start X?); less directive suggestions (Would you like to try X?); offers (Do you want me to give you X?); and assertions (There are medications that might help). It was also coded whether patients accepted, passively resisted (for example, withholding response), or actively resisted (for example, I’ve tried that before).

Results A total of 33 recommendations occurred in 23 consultations. In two-thirds of cases, GPs treated the patient as primary decision-maker by using suggestions, offers, or assertions. In one-third of cases, they used more directive pronouncements or proposals. GPs endorsed treatment moderately (67%), weakly (18%), or strongly (15%). Only one-quarter of recommendations were accepted immediately. Patients cited fears about medication side effects and/or dependency, group therapy, and doubts about treatment efficacy. Despite three-quarters of patients resisting, 76% got prescriptions or self-referral information for talking therapy.

Conclusion Initially, GPs treat patients as the decision-maker. However, although patients resist, most end up with treatment. This may impact negatively on treatment uptake and success. Social prescribing may fill a treatment gap for some patients.

  • mental health
  • social sciences
  • research methods (other)
  • patients
  • primary health care
  • general practice
  • Received August 5, 2019.
  • Accepted August 12, 2019.
  • Copyright © 2019, The Authors

This article is Open Access: CC BY license (https://creativecommons.org/licenses/by/4.0/)

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December 2019
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Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations
Joseph Ford, Felicity Thomas, Richard Byng, Rose McCabe
BJGP Open 2019; 3 (4): bjgpopen19X101670. DOI: 10.3399/bjgpopen19X101670

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Exploring how patients respond to GP recommendations for mental health treatment: an analysis of communication in primary care consultations
Joseph Ford, Felicity Thomas, Richard Byng, Rose McCabe
BJGP Open 2019; 3 (4): bjgpopen19X101670. DOI: 10.3399/bjgpopen19X101670
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Keywords

  • mental health
  • social sciences
  • research methods (other)
  • patients
  • Primary health care
  • general practice

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  • Establishing a Deep End GP group: a scoping review
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