Intervention Review

Psychosocial interventions by general practitioners

  1. Marcus J.H. Huibers1,*,
  2. Anna Beurskens2,
  3. Gijs Bleijenberg3,
  4. Constant Paul van Schayck4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 7 MAY 2007

DOI: 10.1002/14651858.CD003494.pub2


How to Cite

Huibers MJ, Beurskens A, Bleijenberg G, van Schayck CP. Psychosocial interventions by general practitioners. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003494. DOI: 10.1002/14651858.CD003494.pub2.

Author Information

  1. 1

    Maastricht University, Department of Clinical Psychological Science , Maastricht, Netherlands

  2. 2

    Maastricht University, Epidemiology, Maastricht, MD, Netherlands

  3. 3

    Radboud University Nijmegen Medical Centre, Expert Centre for Chronic Fatigue, Nijmegen, HB, Netherlands

  4. 4

    Maastricht University , Department of General Practice, Maastricht, Netherlands

*Marcus J.H. Huibers, Department of Clinical Psychological Science , Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands. m.huibers@dmkep.unimaas.nl. m.huibers@DMKEP.unimaas.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Many patients visit their general practitioner (GP) because of problems that are psychosocial in origin. However, for many of these problems there is no evidence-based treatment available in primary care, and these patients place time-consuming demands on their GP. Therefore, GPs could benefit from tools to help these patients more effectively and efficiently. In this light, it is important to assess whether structured psychosocial interventions might be an appropriate tool for GPs. Previous reviews have shown that psychosocial interventions in primary care seem more effective than usual care. However, these interventions were mostly performed by health professionals other than the GP.

Objectives

To examine the effectiveness of psychosocial interventions by general practitioners by assessing the clinical outcomes and the methodological quality of selected studies.

Search methods

The search was conducted using the CCDANCTR-Studies and CCDANCTR-References on 20/10/2005, The Cochrane Library, reference lists of relevant studies for citation tracking and personal communication with experts.

Selection criteria

Randomised controlled trials, controlled clinical trials and controlled patient preference trials addressing the effectiveness of psychosocial interventions by GPs for any problem or disorder. Studies published before November 2005 were eligible for entry.

Data collection and analysis

Methodological quality was independently assessed by two review authors using the Maastricht-Amsterdam Criteria List. The qualitative and quantitative characteristics of selected trials were independently extracted by two review authors using a standardised data extraction form. Levels of evidence were used to determine the strength of the evidence available. Results from studies that reported similar interventions and outcome measures were meta-analysed.

Main results

Ten studies were included in the review. Selected studies addressed different psychosocial interventions for five distinct disorders or health complaints. There is good evidence that problem-solving treatment by general practitioners is effective for major depression. The evidence concerning the remaining interventions for other health complaints (reattribution or cognitive behavioural group therapy for somatisation, cognitive behavioural therapy for unexplained fatigue, counselling for smoking cessation, behavioural interventions to reduce alcohol reduction) is either limited or conflicting.

Authors' conclusions

In general, there is little available evidence on the use of psychosocial interventions by general practitioners. Of the psychosocial interventions reviewed, problem-solving treatment for depression may offer promise, although a stronger evidence-base is required and the effectiveness in routine practice remains to be demonstrated. More research is required to improve the evidence-base on this subject.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Psychosocial interventions delivered by GPs

Many patients visit their general practitioner (GP) because of psychosocial problems. Consequently, GPs could benefit from tools to help these patients. The reviewers found no strong evidence for the effectiveness (or ineffectiveness) of psychosocial interventions by general practitioners. Of the psychosocial interventions reviewed, problem-solving treatment for depression seems the most promising tool for GPs, although its effectiveness in daily practice remains to be demonstrated.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

由家醫科醫師所執行的心理社會處置

許多的病人因為一些心理社會因素所引發的問題而求診於家醫科醫師(GP)。然而,這些的問題在初級保健上並沒有任何實證上有提供治療,而這些病人似乎相當要求GP來處理這些問題,因此GP也能受益於一些工具,更有效率、更有效果的幫助這些患者。有鑑於此,評估是否結構化的心理處遇對於GP來說可能是一個合適的工具可能相當重要。先前的文獻回顧顯示,社會心理處遇在初級保健上使用比起常規性照顧上更有效。然而,這些處遇大多是由GP以外的健康專業人員來執行。

目標

藉由評估所篩選研究的臨床結果和方法學上的品質來驗證由家醫科醫師所執行心理社會處遇的效果。

搜尋策略

搜尋策略是使用the CCDANCTRStudies 和CCDANCTRReferences on 20/10/2005, The Cochrane Library, 相關 研究的參考文獻表,引文搜尋,與專家溝通。

選擇標準

隨機對照試驗,對照臨床試驗和以病人意願傾向為主的對照試驗,由GP所執行針對任何的問題或疾病的的心理社會處遇的效果。在2005年11月前發表,符合的研究都納入。

資料收集與分析

由2位作者分別使用MaastrichtAmsterdam Criteria List來評估方法學上的品質。由2名的作者分別使用標準化的資料摘錄格式來抽選這些研究的質、量上的特徵。並且將證據分級來決定所得到證據的強度。如果這些研究中使用相似的處置和結果測量,則進行後設分析(metaanalysed).

主要結論

本文獻採用10篇研究,這些研究針對5種不同的疾病或健康問題來探討不同的心理社會處遇。有很好的證據表明,由家醫科醫師所採用的問題解決模式能有效的處理重鬱症。有關於其他健康問題(對身體化症狀再歸因或認知行為團體治療、對不明的疲勞症狀的認知行為治療、對於戒菸的諮商、降低酒精使用的行為處遇)的心理社會處遇的證據也是相當的有限或者證據是有衝突的。

作者結論

一般而言,很少的證據顯示家醫科的醫師使用心理社會處置。在回顧所有的心理社會處置方式中,針對憂鬱的問題解決的治療方式是最有效的方式,雖然仍需要較多的證據支持,而在一般應用的效果也有待證明。目前似乎仍需要較多研究提供證據 。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

由家醫科醫師所執行的心理社會處置 許多病人因為一些心理社會的問題而尋求家醫科醫師的治療。因此家醫科醫師能知道一些方法則更能幫助病人。這篇的文獻回顧並沒有發現很強的證據來支持由家醫科醫師所執行的心理社會處置的效果。在所有的心理社會處置方式的回顧中,對於重鬱症患者,由家醫科醫師實行解決問題的治療似乎是最有希望的工具,儘管它在日常實踐中的有效性還有待證明。