Completely agreed re uncertainty when it comes to intervention outcomes, trying to get any concrete numbers in order to calculate cost-effectiveness almost made me give up, and what I ended up going with is still very nebulous.
When it comes to intervention 2: I absolutely don’t expect any realistic degree of GP education to suddenly make them competent in giving BSD patients fully adequate support. Perhaps I should have better phrased it as “efficiently informing GPs that the guidelines have changed and that they should follow them” rather than “educating GPs”. In this context, I see educating GPs as a neccessary evil: they are the ones gatekeeping access to medication and who will choose whether to follow NICE guidelines or not. I suspect many of them don’t keep up to date with changes in guidelines, so in order for intervention 1 to have any effect it would need to be followed up with somehow translating it into clinical practice. It would be even better if it could be done on autopilot, where the GP can be a Chinese room completely unaware of what BSD even is, just following a flowchart along the lines of “Depressed? Antidepressants didn’t work? Fill out this questionnaire… Scored high? Here’s lamotrigine, please read the leaflet, next!”. This is why implementing, getting approval for and distributing diagnostic and treatment decision making software to be used by GPs for patients with depression could be very effective—I listed it among the concrete steps to take, but perhaps I should have given it more prominence in the interventions list.
Intervention 3 on its own could definitely contribute to GPs taking the correct action—a plucky patient saying “I have BSD, give me lamotrigine!” would hopefully trigger a flow like “BSD? Let me look that up… Okay, I’m supposed to ask you to fill out a questionnaire. Scored high? Here’s lamotrigine, please read the leaflet, next!”.
I have to confess I’m somewhat biased towards a pharmaceutical approach when it comes to BSD. This makes me see the intervention you suggested (connecting patients with people who have a similar problem) specifically in case of BSD more as a means towards an end (the patient getting enough information to convince a GP to prescribe correct medications) rather than a goal in itself (I imagine in many patients, and in my personal experience, no amount of talking with other sufferers, emotional support, group therapy, self-help info etc. would do much to help, while the correct medication would make the problem dissapear completely—though I admit other sufferers might have the opposite experience, which loops back into the whole outcome uncertainty issue).
Specifically in case of BSD, there would also be the issue that by default the patient would seach for “depression support groups” rather than “BSD support groups”. Actually, it would be brilliant if your solution could help people correctly self-diagnose by making them go through a questionnaire-based decision tree, to later direct them to the appropriate group. Perhaps it wouldn’t even need to be categorical or DSM-based, but use some ML solution grouping people according to the weights they’ve given to various symptoms or other markers.
That being said, I think your idea is very interesting! I’d love to talk more about it and potentially get involved—let’s connect :)
Congrats on the social relationships as a metric proposal, it was a fascinating read!
Thanks for the insightful comment!
Completely agreed re uncertainty when it comes to intervention outcomes, trying to get any concrete numbers in order to calculate cost-effectiveness almost made me give up, and what I ended up going with is still very nebulous.
When it comes to intervention 2: I absolutely don’t expect any realistic degree of GP education to suddenly make them competent in giving BSD patients fully adequate support. Perhaps I should have better phrased it as “efficiently informing GPs that the guidelines have changed and that they should follow them” rather than “educating GPs”. In this context, I see educating GPs as a neccessary evil: they are the ones gatekeeping access to medication and who will choose whether to follow NICE guidelines or not. I suspect many of them don’t keep up to date with changes in guidelines, so in order for intervention 1 to have any effect it would need to be followed up with somehow translating it into clinical practice. It would be even better if it could be done on autopilot, where the GP can be a Chinese room completely unaware of what BSD even is, just following a flowchart along the lines of “Depressed? Antidepressants didn’t work? Fill out this questionnaire… Scored high? Here’s lamotrigine, please read the leaflet, next!”. This is why implementing, getting approval for and distributing diagnostic and treatment decision making software to be used by GPs for patients with depression could be very effective—I listed it among the concrete steps to take, but perhaps I should have given it more prominence in the interventions list.
Intervention 3 on its own could definitely contribute to GPs taking the correct action—a plucky patient saying “I have BSD, give me lamotrigine!” would hopefully trigger a flow like “BSD? Let me look that up… Okay, I’m supposed to ask you to fill out a questionnaire. Scored high? Here’s lamotrigine, please read the leaflet, next!”.
I have to confess I’m somewhat biased towards a pharmaceutical approach when it comes to BSD. This makes me see the intervention you suggested (connecting patients with people who have a similar problem) specifically in case of BSD more as a means towards an end (the patient getting enough information to convince a GP to prescribe correct medications) rather than a goal in itself (I imagine in many patients, and in my personal experience, no amount of talking with other sufferers, emotional support, group therapy, self-help info etc. would do much to help, while the correct medication would make the problem dissapear completely—though I admit other sufferers might have the opposite experience, which loops back into the whole outcome uncertainty issue).
Specifically in case of BSD, there would also be the issue that by default the patient would seach for “depression support groups” rather than “BSD support groups”. Actually, it would be brilliant if your solution could help people correctly self-diagnose by making them go through a questionnaire-based decision tree, to later direct them to the appropriate group. Perhaps it wouldn’t even need to be categorical or DSM-based, but use some ML solution grouping people according to the weights they’ve given to various symptoms or other markers.
That being said, I think your idea is very interesting! I’d love to talk more about it and potentially get involved—let’s connect :)
Congrats on the social relationships as a metric proposal, it was a fascinating read!