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Biomedical subjects

Kelsey Hegarty

Publications and source records attributed to Kelsey Hegarty.

10 recordsLinked to original sources
PubMed2006

A systematic review of complex system interventions designed to increase recovery from depression in primary care.

BACKGROUND: Primary care is being encouraged to implement multiprofessional, system level, chronic illness management approaches to depression. We undertook this study to identify and assess the quality of RCTs testing system level depression management interventions in primary care and to determine whether these interventions improve recovery. METHOD: Searches of Medline and Cochrane Controlled Register of Trials. 'System level' interventions included: multi-professional approach, enhanced inter-professional communication, scheduled patient follow-up, structured management plan. RESULTS: 11 trials met all inclusion criteria. 10 were undertaken in the USA. Most focussed on antidepressant compliance. Quality of reporting assessed using CONSORT criteria was poor. Eight trials reported an increase in the proportion of patients recovered in favour of the intervention group, yet did not account for attrition rates ranging from 5 to 50%. CONCLUSION: System level interventions implemented in the USA with patients willing to take anti-depressant medication leads to a modest increase in recovery from depression. The relevance of these interventions to countries with strong primary care systems requires testing in a randomised controlled trial.

Antidepressive Agents↗
PubMed2006

Putting woman-centered care into practice: a new (ANEW) approach to psychosocial risk assessment during pregnancy.

BACKGROUND: When antenatal care is provided, identification and management of challenging problems, such as depression, domestic violence, child abuse, and substance abuse, are absent from traditional midwifery and medical training. The main objective of this project was to provide an alternative to psychosocial risk screening in pregnancy by offering a training program (ANEW) in advanced communication skills and common psychosocial issues to midwives and doctors, with the aim of improving identification and support of women with psychosocial issues in pregnancy. METHODS: ANEW used a before-and-after survey design to evaluate the effects of a 6-month educational intervention for health professionals. The setting for the project was the Mercy Hospital for Women in Melbourne, Australia. Surveys covered issues, such as perceived competency and comfort in dealing with specific psychosocial issues, self-rated communication skills, and open-ended questions about participants' experience of the educational program. RESULTS: Educational program participants (n = 22/27) completed both surveys. After the educational intervention, participants were more likely to ask directly about domestic violence (p = 0.05), past sexual abuse (p = 0.05), and concerns about caring for the baby (p = 0.03). They were less likely to report that psychosocial issues made them feel overwhelmed (p = 0.01), and they reported significant gains in knowledge of psychosocial issues, and competence in dealing with them. Participants were highly positive about the experience of participating in the program. CONCLUSIONS: The program increased the self-reported comfort and competency of health professionals to identify and care for women with psychosocial issues.

Adult↗
PubMed2005

How do Victorian GPs manage patients with depression?

BACKGROUND: Depression is common, yet management in general practice is poorly described, especially the relationship between medication use and focussed psychological strategies. Government initiatives are targeting general practitioners' provision of mental health care. METHODS: Postal survey of a random sample of 350 Victorian GPs between November 2001 and April 2002. RESULTS: Forty-eight percent response rate. Most GPs reported prescribing medication (82%) or providing supportive counselling (87%) to most patients with mild to moderate major depression, while few (<20%) reported frequently using focussed psychological strategies. Training in psychiatry or focussed psychological strategies was associated with use of psychological therapies. DISCUSSION: Future education programs that support GPs to overcome barriers to using focussed psychological strategies may provide more effective care.

Adult↗
PubMed2005

The composite abuse scale: further development and assessment of reliability and validity of a multidimensional partner abuse measure in clinical settings.

Absence of a well-validated comprehensive partner abuse questionnaire has been a major methodological issue in domestic violence research. A new multidimensional measure of partner abuse, the Composite Abuse Scale (CAS), has four dimensions: Severe Combined Abuse, Emotional Abuse, Physical Abuse, and Harassment. A general practice patient sample (N = 1,836) has been used in the development and testing of CAS. Factor analyses in this current study confirmed the four dimensions from a preliminary nurses sample study and resulted in a final scale of 30 items consisting of acts of physical, emotional, and sexual abuse. These four factors exhibited good internal reliability (Cronbach's alpha > 0.85) and the corrected item-total correlations were high (> 0.5). Evidence of criterion and construct validity is presented.

Adolescent↗
PubMed2004

Association between depression and abuse by partners of women attending general practice: descriptive, cross sectional survey.

OBJECTIVE: To explore the association between depression and physical, emotional, and sexual abuse by partners or ex-partners of women attending general practice. DESIGN: Descriptive, cross sectional survey. SETTING: 30 general practitioners in Victoria, Australia. PARTICIPANTS: 1257 consecutive female patients. MAIN OUTCOME MEASURES: Some type of abuse in an adult intimate relationship (composite abuse scale), depression (Beck depression inventory or Edinburgh postnatal depression scale), and physical health (SF-36). RESULTS: 18.0% (218/1213) of women scored as currently probably depressed and 24.1% (277/1147) had experienced some type of abuse in an adult intimate relationship. Depressed women were significantly more likely to have experienced severe combined abuse than women who were not depressed after adjusting for other significant sociodemographic variables (odds ratio 5.8, 95% confidence interval 2.8 to 12.0). These variables included not being married, having a poor education, being on a low income, being unemployed or receiving a pension, pregnancy status, or being abused as a child. CONCLUSION: Physical, emotional, and sexual abuse are strongly associated with depression in women attending general practice. Doctors should sensitively ask depressed women about their experiences of violence and abuse in intimate relationships. Research into depression should include measures of partner abuse in longitudinal and intervention studies.

Adolescent↗
PubMed2003

Women teaching women's health: issues in the establishment of a clinical teaching associate program for the well woman check.

The impact of screening programs for cervical cancer would be increased with the greater participation of currently underscreened women. Training for medical students and doctors in the fine technical and communication skills required in breast and gynaecological examinations would improve participation by increasing the confidence and skill of doctors in raising the issue of screening, thereby making the examination a more positive experience for women. Gynaecology Teaching Associate (GTA) programs, using specially trained standardized patients, have been used in over 90% of American and Canadian medical schools for more than ten years to provide such training. Australia has been slow to adopt this teaching method. A Clinical Teaching Associates in Gynaecology program (CTA) was first established in 1996 by the Department of Obstetrics and Gynaecology at the University of Queensland, building on the Pap test program from Adelaide. Other medical schools subsequently introduced such programs and in 2000, the Department of General Practice, University of Melbourne, established a CTA program based on the Queensland program, with a grant from PapScreen Victoria. This paper describes the methods of recruitment and training of CTAs, use of CTAs in the medical course, preliminary evaluation, and ethical and other issues in the Melbourne and Queensland University programs.

Communication↗
PubMed2003

Use of antidepressant medications in the general practice setting. A critical review.

BACKGROUND: Antidepressants are commonly prescribed in general practice for depression, but also for a wide range of other psychiatric conditions and physical problems. OBJECTIVE: This review, although concentrating on the use of antidepressants in depression, also reviews their use in other conditions commonly seen in general practice. DISCUSSION: For most major depression, all antidepressant drugs have equal efficacy. The choice of antidepressant drug needs to be tailored to the particular patient's medical condition and personal preferences. It is likely that adverse effects are the major determinant in the choice of antidepressant for a particular patient. However, in treating conditions other than depression, the efficacy of the antidepressant drug can be the primary issue of drug choice.

Antidepressive Agents↗