How Receptive are Primary Care Patients to Self Administered Treatment

Patients have preferences for the type of treatment that they receive and many individuals prefer behavioral over pharmaceutical methods to address health and mental health difficulties. For example, Van Schaik et al. (2004) reviewed the literature on preference in primary care for treatments of major depression. Six studies were included in the review and all showed that primary care patients preferred psychotherapy to antidepressant medication, by a factor of no less than 2:1. Arean and Miranda (1996) evaluated 131 primary care patients' views about the acceptability of psychological treatments for medical problems, stress, and depression. Among distressed patients (i.e., those achieving a t score > 60 on any subscale of the Symptom Checklist-90, SCL-90; Derogatis, 1977), 68% indicated a willingness to attend a psychological group treatment for a medical problem, 64% for stress, and 63% for depression. Level of somatic symptoms did not predict willingness to attend a psychological group treatment.

Consumers typically engage in a high level of self-administered treatment for various health problems. Segall and Goldstein (1989) inquired about treatment preference for a variety of physical ailments using a randomly selected community sample of 524 adults. Participants were asked "What type of treatment would you use if you experienced this condition?" The conditions included feelings of dizziness, bowel irregularity, constant tiredness, frequent headaches, rash or itch, shortness of breath, unexplained loss of weight, difficulty sleeping at night, loss of appetite, and stomach upset/indigestion. Respondents indicated that they were more likely to use self-administered treatment with stomach upset, bowel irregularity, and difficulty sleeping, while for weight loss, shortness of breath, and frequent headaches they were more likely to choose to visit a physician. Being younger, unmarried, and female were associated with the intention to engage in self-administered treatment for common health problems. In the United Kindgom, Graham, Franses, Kenwright, and Marks (2000) posted a survey on an Internet Web site to assess opinions about self-help for obsessive-compulsive disorder and agoraphobia. Surveys were sent by mail to those who agreed to participate and there was a 35% return rate. Participants indicated (with a yes or no response) whether they would like access to self-administered treatment through any of several different modalities. A total of 91% gave a positive response to the idea of accessing self-administered treatment by computer (of these, 43% indicated a computer to be based at home and 23% at the primary care clinic), 35% endorsed Internet access, 56% indicated access through an interactive voice-response system, and 62% endorsed access through print materials. Thus, even though the sample was recruited through the Internet and so may have been particularly receptive to new technology, sizeable numbers of respondents were receptive to print-based manuals, computer-assisted treatment, and telephone interactive voice-response systems.

Williams (2003) discussed predictors of outcome in self-help and indicated that those who have negative attitudes toward the self-help format, poor concentration and memory, and weak visual processing would be least likely to benefit from self-help. These authors suggest that those with an internal locus of control and more self-efficacy are the best candidates for self-administered treatments.

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