Designing Effective CME—Potential Barriers to Practice Change in the Management of Depression: A Qualitative Study

Abstract

Aim: The main aim of the current study is to explore GPs’ micro level obstacles of behavior change which affects diagnosis and management of Depressive Disorders following attendance at a Depression CME event. Methods: In this qualitative study, semi-structured interviews exploring GPs’ perceptions and experiences regarding the diagnosis and treatment of depression were done. A purposeful sampling to obtain a broad range of views was carried out among GPs that had participated in an educational intervention study three years earlier. Eleven GPs were interviewed and their views were probed in depth to get rich descriptions to ensure trustworthiness of the data. The data were analyzed by using qualitative content analysis. Results: GPs’ beliefs regarding micro level barriers emerged as two important themes individual and workplace factors. The individual themes included: educational and professional, and the contextual themes included: psychological disorders and work place categories. The results showed different perceptions on the barriers between the two groups of GPs, those who did change and had a positive perception of the CME program they participated in three years ago, and some who did not change. Conclusion: The results of this study imply that a number of micro level obstacles were of great importance when managing patients with depression disorders. In order to improve the effectiveness of CME events they should be tailored for the individual and address workplace issues i.e. both individual and contextual factors need attention.

Share and Cite:

Shirazi, M. , Parikh, S. , Dadgaran, I. & Silén, C. (2013). Designing Effective CME—Potential Barriers to Practice Change in the Management of Depression: A Qualitative Study. Psychology, 4, 25-31. doi: 10.4236/psych.2013.411A005.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Amin, Z. (2000). Theory and practice in continuing medical education. Annals of the Academy of Medicine, Singapore, 29, 498-502.
[2] Chew-Graham, C. A., Mullin, S., May, C. R., Hedley, S., & Cole, H. (2002). Managing depression in primary care: Another example of the inverse care law? Family Practice, 19, 632-637.
http://dx.doi.org/10.1093/fampra/19.6.632
[3] Davis, D. A., Thomson, M. A., Oxman, A. D., & Haynes, R. B. (1995). Changing physician performance. JAMA: The Journal of the American Medical Association, 274, 700-705.
http://dx.doi.org/10.1001/jama.1995.03530090032018
[4] Diner, B. M., Carpenter, C. R., O’Connell, T., Pang, P., Brown, M. D., Seupaul, R. A., Mayer, D., et al. (2007). Graduate medical education and knowledge translation: Role models, information pipelines, and practice change thresholds. Academic Emergency Medicine, 14, 1008-1014.
[5] Dogra, N., Hoschl, C., Moussaoui, D., Gask, L., Coskun, B., & Baron, D. (2010). Developing a medical student curriculum in psychiatry. In L. Gask, B. Coskun, & D. A. Baron (Eds.), Teaching Psychiatry: Putting Theory into Practice (pp. 27-46), Hoboken, NJ: Wiley.
[6] Elo, S., & Kyngas, H. (2008). The qualitative content analysis process. Journal of advanced nursing, 62, 107-115.
http://dx.doi.org/10.1111/j.1365-2648.2007.04569.x
[7] Grol, R., & Wensing, M. (2004). What drives change? Barriers to and incentives for achieving evidence-based practice. The Medical Journal of Australia, 180, S57.
[8] Hannes, K., Leys, M., Vermeire, E., Aertgeerts, B., Buntinx, F., & Depoorter, A.-M. (2005). Implementing evidence-based medicine in general practice: A focus group based study. BMC Family Practice, 6, 37. http://dx.doi.org/10.1186/1471-2296-6-37
[9] Jewell, D. (2003). How to change clinical behaviour: No answers yet. The British Journal of General Practice, 53, 266.
[10] Krippendorff, K. (2004). Book review: Content analysis: An introduction to its methodology (2nd ed.). Organizational Research Methods, 13, 392-394.
[11] Kvale, K. (2007). Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. European Journal of Oncology Nursing, 11, 320-327.
http://dx.doi.org/10.1016/j.ejon.2007.01.002
[12] Lecrubier, Y. (2007). Widespread underrecognition and undertreatment of anxiety and mood disorders: Results from 3 European studies. The Journal of Clinical Psychiatry, 68, 36-41.
[13] Marandi, A. (1996). Integrating medical education and health services: the Iranian experience. Med Educ, 30, 4-8.
http://dx.doi.org/10.1111/j.1365-2923.1996.tb00709.x
[14] Marinopoulos, S. S., Dorman, T., Ratanawongsa, N., Wilson, L. M., Ashar, B. H., Magaziner, J. L., Qayyum, R., et al. (2007). Effectiveness of continuing medical education. Evidence Reports/Technology Assessments, 149, 1-69.
[15] Mitchell, A. J., Vaze, A., & Rao, S. (2009). Clinical diagnosis of depression in primary care: A meta-analysis. The Lancet, 374, 609-619.
http://dx.doi.org/10.1016/S0140-6736(09)60879-5
[16] Oxman, A. D., Thomson, M. A., Davis, D. A., & Haynes, R. B. (1995). No magic bullets: A systematic review of 102 trials of interventions to improve professional practice. CMAJ: Canadian Medical Association Journal, 153, 1423.
[17] Palmquist, M. (2010). Writing guide: Content analysis. Fort Collins, CO: Colorado State University.
[18] Pellegrino, E. D. (2002). Professionalism, profession and the virtues of the good physician. Mount Sinai Journal of Medicine, 69, 378-384.
[19] Pierce, D., & Gunn, J. (2007). GPs’ use of problem solving therapy for depression: A qualitative study of barriers to and enablers of evidence based care. BMC Family Practice, 8, 24.
http://dx.doi.org/10.1186/1471-2296-8-24
[20] Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change. Applications to Addictive Behaviours, 47, 1102-1114.
[21] Pope, C., Van Royen, P., & Baker, R. (2002). Qualitative methods in research on healthcare quality. Quality and Safety in Health Care, 11, 148-152. http://dx.doi.org/10.1136/qhc.11.2.148
[22] Rimer, B. K., & Glanz, K. (2005). Theory at a glance: A guide for health promotion practice. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Cancer Institute.
[23] Shirazi, M., Gandomkar, R., Ponzer, S., & Silén, C. (2013). Exploring the macro level barriers that affect Iranian GPs’ diagnosis and management of depression disorders. European Journal for Person Centered Healthcare, 1. (in Press) www.bjll.org/index.php/ejpch
[24] Shirazi, M., Lonka, K., Parikh, S. V., Ristner, G., Alaeddini, F., Sadeghi, M., & Wahlstrom, R. (2011). A tailored educational intervention improves doctor’s performance in managing depression: A randomized controlled trial. Journal of Evaluation in Clinical Practice, 19, 16-24. http://dx.doi.org/10.1111/j.1365-2753.2011.01761.x
[25] Shirazi, M., Assadi, S. M., Sadeghi, M., Zeinaloo, A. A., Kashani, A. S., Arbabi, M., Wahlstrom, R., et al. (2007). Applying a modified Prochaska’s model of readiness to change for general practitioners on depressive disorders in CME programmes: Validation of tool. Journal of Evaluation in Clinical Practice, 13, 298-302.
http://dx.doi.org/10.1111/j.1365-2753.2006.00735.x
[26] Shirazi, M., Parikh, S. V., Alaeddini, F., Lonka, K., Zeinaloo, A. A., Sadeghi, M., Wahlstrom, R., et al. (2009). Effects on knowledge and attitudes of using stages of change to train general practitioners on management of depression: A randomized controlled study. Canadian Journal of Psychiatry, 54, 693-700.
[27] Shirazi, M., Sadeghi, M., Emami, A., Kashani, A. S., Parikh, S., Alaeddini, F., Wahlstrom, R., et al. (2011). Training and validation of standardized patients for unannounced assessment of physicians’ management of depression. Academic Psychiatry, 35, 382-387.
http://dx.doi.org/10.1176/appi.ap.35.6.382
[28] Shirazi, M., Zeinaloo, A., Parikh, S., Sadeghi, M., Taghva, A., Arbabi, M., Wahlstrom, R., et al. (2008). Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model—A randomized controlled study. Family Practice, 25, 98-104.
http://dx.doi.org/10.1093/fampra/cmn008
[29] Shirazi, M., Zeinaloo, A., Sabouri, K., & Alaedini, F. (2004). Assessing the gap between current and desirable needs in TUMS CME Unit: Participants viewpoints. Iranian Journal of Medical Education, 5, 17-22.
[30] Westbrook, L. (1994). Qualitative research methods: A review of major stages, data analysis techniques, and quality controls. Library & Information Science Research, 16, 241-254.
http://dx.doi.org/10.1016/0740-8188(94)90026-4
[31] Wilhelm, K., Brownhill, S., Harris, J., & Harris, P. (2006). Depression—What should the doctor ask? Australian Family Physician, 35, 163-165.
[32] Wilson, S., Eagles, J. M., Platt, J. E., & McKenzie, H. (2007). Core undergraduate psychiatry: What do non-specialists need to know? Medical Education, 41, 698-702.
http://dx.doi.org/10.1111/j.1365-2923.2007.02790.x
[33] World Health Organization (2004). Prevention of mental disorders: Effective interventions and policy options: Summary report. Geneva: World Health Organization
[34] Zhang, Y. (2012). College students’ uses and perceptions of social networking sites for health and wellness information.
http://informationr.net/ir/17-3/paper523.html

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.