Abstract
BackgroundDepression constitutes a significant part of the global burden of diseases. General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. However, the current use of telemedicine solutions in the field of general practice is limited. This study aims to explore barriers and facilitators to using a web-based version of the Major Depression Inventory (eMDI) for psychometric testing of potentially depressive patients in general practice.MethodsSemi-structured individual interviews were conducted with nine general practitioners (GPs) from eight general practices in the Central Denmark Region. All interviewees had previous experience in using the eMDI in general practice. Determinants for using the eMDI were identified in relation to the GPs’ capability, opportunity and motivation to change clinical behaviour (the COM-B system).ResultsOur results indicate that the main barriers for using the eMDI are related to limitations in the GPs’ opportunity in regards to having the time it takes to introduce change. Further, the use of the eMDI seems to be hampered by the time-consuming login process. Facilitating factors included behavioural aspects of capability, opportunity and motivation. The implementation of the eMDI was facilitated by the interviewees’ previous familiarity with the paper-based version of the tool. Continued use of the eMDI was facilitated by a time-saving documentation process and motivational factors associated with clinical core values. These factors included perceptions of improved consultation quality and services for patients, improved possibilities for GPs to prioritise their patients and improved possibilities for disease monitoring. Furthermore, the flexible nature of the eMDI allowed the GPs to use the paper-based MDI for patients whom the eMDI was not considered appropriate.ConclusionsImplementation of a telemedicine intervention in general practice can be facilitated by resemblance between the intervention and already existing tools as well as the perception among GPs that the intervention is time-saving and improves quality of care for the patients.
Highlights
IntroductionGeneral practice plays a central role in diagnosing and monitoring depression
Depression constitutes a significant part of the global burden of diseases
General practice plays a central role in the diagnosis and monitoring of depression [2, 3], and many general practitioners (GPs) use psychometric tools for assessment
Summary
General practice plays a central role in diagnosing and monitoring depression. A telemedicine solution comprising a web-based psychometric tool may reduce number of visits to general practice and increase patient empowerment. General practice plays a central role in the diagnosis and monitoring of depression [2, 3], and many general practitioners (GPs) use psychometric tools for assessment. The most frequently used tool in Denmark is the Major Depression Inventory (MDI), and Danish GPs are remunerated for undertaking psychometric testing [2]. The MDI is a self-report questionnaire in which the patient scores the frequency of his or her symptoms during the last 2 weeks [4] It explores the ICD-10 criteria for depression in a questionnaire form. On the basis of the patient’s individual symptom score, the GP calculates an overall MDI summary score, which serves as a measure of depression severity (mild, moderate or severe) and for monitoring changes over time
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