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Why Do General Practitioners Recommend or Not Recommend Computer-Delivered Cognitive Behavioural Therapy (CCBT) for Depression?
Date
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350 million people are affected worldwide
By 2020, depression will be the 2nd highest cause of disability worldwide
Facts about Depression
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One in six New Zealanders will experience depressionduring their lifetime
Depression in NZ
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2 main types of treatment:
1.Pharmacotherapy2.Psychotherapy
Treatment of Depression
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Most common type of psychotherapy for depression
Cognitive Behavioural Therapy (CBT)
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- Expensive
- Difficult to access especially in rural areas
- Few specialists offer CBT
- Long waiting lists
Disadvantages of CBT
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Computer-delivered Cognitive Behavioural Therapy (CCBT)
Kaltenhaler and Cavanagh (2010) - a different method of delivering CBT usually through the use of a computer interface but it uses patient inputs to make psychotherapeutic decisions.
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- Often free of charge- Easily accessible- Offers flexibility- Increases privacy
Advantages of CCBT
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Breakdown of Beating the Blues usage in New Zealand between March, 2011 and March, 2014 (MOH, 2014)
Usage of CCBT in NZ
Prescribed Not activated
Activated
5931 2636 3295
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about 600,000 people diagnosed with depression between 2011- 2012
NZ Health Survey 2011-2012 (MHF)
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Act as gatekeepers to the use of CCBT programs
Role of GPs
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Service providers have negative attitudes towards CCBT which may have compromised the use of CCBT.
Du E, Quayle E, McLeod H (2013)
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To determine the attitudes and perceptions of GPs towards CCBT for depression
Objective of the Study
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Qualitative approach
Data gathering: Semi-structuredInterviews
Data analysis: General Inductive Approach
Methods
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10 GP participants; No Maori GPs
Recruitment: Referrals fromProfessors/Lecturers working at the University of Auckland (Convenience Sampling)
Methods
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Acquired from the University of Auckland Human Participants Ethics Committee (UAHPEC)
Ethics approval
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Sex: 5 males ; 5 females
Location:9 urban GPs; 1 rural GP
Age group: 6 GPs(40-50 age group);2 GPs(50-60 age group);2 GPs(30-40 age group)
Demographics of Participants
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9/10 participants – Positive Perception of CCBT
9/10 participants – Aware of CCBT
General Summary of Results
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7/10 participants – had used CCBT for their patients
7/10 participants – would continue to use CCBT for their patients in the future
General Summary of Results
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Theme 1 – Advantages of CCBT
Theme 2 – Disadvantages of CCBT
Theme 3 – Indications for the Use of CCBT
5 Themes
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Theme 4 – Contraindications for the use of CCBT
Theme 5 – Requirements for the use of CCBT
5 Themes
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Positive features of CCBT
What makes CCBT favourable to use
Theme 1 – Advantages of CCBT
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-Free-No waiting list-Increased accessibility -Increased Flexibility-Increased privacy
Theme 1 – Advantages of CCBT
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“Well , I think they are a good thing in terms of enabling people to get access to therapies in their own time, cheaply if they are free, and the privacy thing. So, I think there are good reasons for them and accessibility.”
Theme 1 – Advantages of CCBT
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Negative features of CCBT
What makes CCBT unfavourable for use
Theme 2 – Disadvantages of CCBT
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Lack of GP knowledge about CCBTSafety issuesPatients do not usually finish the programs
Theme 2 – Disadvantages of CCBT
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Theme 2 – Disadvantages of CCBT
“I haven’t referred any adolescents with depression for computerised therapies. I guess because I don’t know of a successful tool or computerised therapy tailored to adolescents. Then if I knew one then I might refer.”
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Reasons for referring patients with depression to CCBT
Theme 3 – Indications for Use of CCBT
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Mild to moderate depressionSevere depression on the waiting list for a specialistComplement to face to face therapy
Theme 3 - Indications for Use of CCBT
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Patients who do not like face to face therapy
Adolescent patients
Theme 3 – Indications for Use of CCBT
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“Umm, yes. I have referred patients for computerised therapies. Why do I refer those people? The criteria are that they are mild. Ok? At most,moderate.”
Theme 3 – Indications for Use of CCBT
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Reasons for not referring patients to CCBT
Theme 4 - Contra-indications to the Use of CCBT
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No access to computersElderly patientsSevere depression
Theme 4 - Contra-indications to the Use of CCBT
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“I think as a young person is diagnosed with a significant anxiety and depression we are not going to rely on any therapy by itself in isolation.”
Theme 4 - Contra-indications to the Use of CCBT
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What GPs would require about CCBT in order for them to have more confidence in referring their patients to CCBT.
Theme 5 –Requirementsto the use of CCBT
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More studies regarding the effectiveness of CCBT
Access to computers
Patients need to be motivated
Theme 5 –Requirementsto the use of CCBT
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“I do use it already, I suppose. Umm, it would be good to get some more numbers. It is my understanding that it is as effective as face-to- face treatments. Umm, but I suppose if I have some more facts on its efficacy and you know what population is best suited for would help me to direct my treatment towards them.”
Theme 5 –Requirementsto the use of CCBT
“
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Most of the GPs had a positive perception of CCBT
The majority of the GPs had used CCBT in their patients and will continue to use them in the future
Conclusion
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GPs may not be the reasonfor the decreased uptake of CCBT programs for depression.
Conclusion
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Small study sample
Sampling bias
Limitations of the Study
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Qualitative Research Approach ------ In-depth interviews----Gather Rich data
Small Study Sample
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1.The research is a Dissertation
2.There is a general impression that GPs do not frequently refer patients to CCBT.
3 Factors for Sampling Bias:
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3.The study is anexploratory study which made use of convenience sampling.
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-Fast- Inexpensive- Produces valid results
Advantages of Convenience Sampling:
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Further studies using a cross sectional study design of a larger group of GP participants
Further qualitative studies on patients who drop out from the programs
Recommendations
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Awareness and knowledge of CCBTmust be increased through direct marketing and advertising of CCBTto service providers as well as increasing awareness through symposia and seminars
Recommendations
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Evidence from studies about CCBT should be made readily available to GPs
Recommendations
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End
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