چکیده (انگلیسی):

Background:Improving the patient experience of primary care is a stated focus of efforts to transform primary care
practices into“Patient-centered Medical Homes” (PCMH) in the United States, yet understanding and promoting
what defines a positive experience from the patient’s perspective has been de-emphasized relative to the development
of technological and communication infrastructure at the PCMH. The objective of this qualitative study was to compare
primary care clinicians’ and their patients’ perceptions of the patients’ experiences, expectations and preferences as they
try to achieve care for depression.
Methods:We interviewed 6 primary care clinicians along with 30 of their patients with a history of depressive disorder
attending 4 small to medium-sized primary care practices from rural and urban settings.
Results:Three processes on the way to satisfactory depression care emerged: 1. a journey, often from fractured to
connected care; 2. a search for a personal understanding of their depression; 3. creation of unique therapeutic spaces
for treating current depression and preventing future episodes. Relative to patients’ observations regarding stigma’s
effects on accepting a depression diagnosis and seeking treatment, clinicians tended to underestimate the presence
and effects of stigma. Patients preferred clinicians who were empathetic listeners, while clinicians worried that
discussing depression could open“Pandora’sbox”of lengthy discussions and set them irrecoverably behind in their
clinic schedules. Clinicians and patients agreed that somatic manifestations of mental distress impeded the patients’
ability to understand their suffering as depression. Clinicians reported supporting several treatment modalities beyond
guideline-based approaches for depression, yet also displayed surface-level understanding of the often multifaceted
support webs their patient described.
Conclusions:Improving processes and outcomes in primary care may demand heightened ability to understand and
measure the patients’ experiences, expectations and preferences as they receive primary care. Future research would
investigate a potential mismatch between clinicians’ and patients’ perceptions of the effects of stigma on achieving
care for depression, and on whether time spent discussing depression during the clinical visit improves outcomes.
Improving care and outcomes for chronic disorders such as depression may require primary care clinicians to
understand and support their patients’ unique‘therapeutic spaces.’