What are the GP perceived barriers and facilitators to identifying and managing depression in post-stroke patients?: A qualitative study

Problem

More patients are now surviving strokes and are cared for in the community sooner through early supported discharge teams. However, rehabilitation tends to focus on a physical recovery and patients with emotional difficulties may not be identified. Post-stroke depression affects around one in three patients. It can have a negative impact on patients’ quality of life and wellbeing and therefore early diagnosis and treatment are vital. General Practitioners (GPs) are key community healthcare professionals responsible for physical, psychological and social aspects of care, who have frequent contact with patients, making them well placed to identify and treat depression in patients following a stroke. This study aimed to understand the barriers and facilitators that GPs perceive in identifying and managing depression in patients following stroke, in the addition to finding potential improvements to current services.

Approach

Purposive sampling was used to recruit GPs across East Lancashire to participate in one to one semi-structured interview based on the Theoretical Domain Framework (TDF). Audio-recorded interviews were transcribed and analysed by two independent reviewers, facilitated by NVIVO 11. A third and fourth researcher reviewed the key themes to ensure trustworthiness. Any differences between the reviewers were discussed until agreement was reached.

Findings

Ten GPs were interviewed. Perceived barriers and facilitators to identification and management of depression fell within the TDF domains of “Environmental context and resources”, “Social/professional role and identity”, and “Knowledge”. Facilitators included “Collaborative working” as GPs described the benefit of good communication with other healthcare professionals to identify psychological distress in patients. “Comprehensive approach” was another facilitator, as GPs held a strong belief that it was their role to identify depression. However, barriers included “Lack of formal pathway in identification, treatment and management of depression”, which led to confusion over which healthcare professionals should provide treatment and support of patients following stroke. “Time Restraints” was another barrier, which GPs felt forced them to focus on physical recovery in initial appointments, with psychological distress often addressed in later appointments. GPs felt this problem could be addressed through specific appointments with patients to discuss psychological issues. Moreover, a discussion with the patient prior to their discharge from hospital about the psychological problems they might face may be beneficial to signpost patients to appropriate services.

Consequences

GPs play an important role in the care of stroke patients in the community. The importance of implementing a formal psychological care pathway and effective communication between GPs and other healthcare professionals was recognised. The importance of improving awareness for the roles of other services was also highlighted. Further research is needed to explore effective methods for recognising and managing depression following stroke in primary care.