Barriers to and facilitators for referral to blended internet-based depression treatment in primary care

Abstract

Theory: Major Depression with an estimated lifetime prevalence of 13% is frequently managed in primary care. Guidelines recommend medication and/or psychotherapy. However, general practitioners only report high rates of self-confidence for medication and patients often remain untreated or are confronted with long waiting lists for psychotherapy. Internet-based interventions have shown to be effective in treating depression and can potentially overcome the limitations of traditional treatment services. However treatment referral rates of patients to internet-based treatments from GPs are often low and implementation in primary care seems to be hampered with difficulties. The aim of this study is to identify general practitioner’s perceived barriers to and facilitators for referring patients to blended internet-based psychotherapy for depression. Method: Semi-structured interviews will be conducted with general practitioners involved in a RCT trial on blended care (10 internet-based + 5 f2f psychological sessions) in Germany (E-Compared). Interview questions will be based on a theoretical framework (Normalisation Process Theory) as well as clinical expertise and will address experiences of general practitioners with referring patients to a short-time internet-based depression treatment. Existing standard routines for diagnosing, treating and referring patients will be explored and obstacles as well as facilitators for referral rates identified. Interviews will be recorded, transcribed verbatim and analysed using content analysis. Results: Description of generated themes and categories is planned. Current stage of work: Development of the interview guide for the interviews in April 2016. Conclusions: Derivation of strategies to overcome barriers to referrals enables the implementation of blended treatment in primary care.