Primary Care Physicians' Evaluation and Treatment of Depression

Abstract

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics. Keywords depression; physician decision making; primary care; standardized patients Depression is common among primary care patients, but it is often underrecognized and undertreated (Kessler et al., 2005;Simon, Fleck, Lucas, & Bushnell, 2004; A. S. Young, Klap, Readers who are interested in receiving copies of the transcripts of the case vignettes used in this study may contact Lisa M. Hooper at E-mail: lhooper@bamaed.ua.edu.. NIH Public Access Author ManuscriptMed Care Res Rev. Author manuscript; available in PMC 2009 December 1. Published in final edited form as:Med Care Res Rev. 2008 December ; 65(6): 674-695. doi:10.1177/1077558708320987. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript Sherbourne, & Wells, 2001). Detection rates have increased in recent years, but fewer than half of patients receive adequate acute-phase treatment Simon et al., 2004; A. S. Young et al., 2001). Recent changes in health care delivery have resulted in an increased emphasis on primary care treatment of depression. For example, one major insurer recently decided to pay primary care physicians to use a depression screener for patients with chronic medical conditions (Aetna, 2005). Many patients receive suboptimal care because of structural factors such as visit length and other difficulties that physicians encounter when working in health systems that do not support primary care treatments for disorders such as depression. In addition, some physicians provide suboptimal communication behaviors such as patient education (Simon, 1998). Physicians' delivery of specific educational messages (e.g., continue the medication even if you are feeling better) have been associated with increased adherence (Bull et al., 2002;Lin et al., 1995). In a recent study, patients with mild to moderate severity received poorer care than did those with minimal or extremely severe symptoms (Joo, Solano, Mulsant, Reynolds, & Lenze, 2005). Adherence to depression treatmen...

General Practitioners' Choices and Their Determinants When Starting Treatment for Major Depression: A Cross Sectional, Randomized Case-Vignette Survey

“…Our finding that GPs would prescribe antidepressants less often to women than men is consistent with some publications [8], but contradicts others, which either found no association [13], [40] or an inverse one [41], [42]. Gender differences in diagnosis and treatment of depression found in population studies [16] have been ascribed to women seeking medical care more often than men, verbalizing their symptoms more effectively, and requesting medication more often [15].…”

“…Although antidepressants remained the treatment chosen most frequently by our study's participants (66.2%), this percentage is moderate compared with other studies, where it sometimes exceeded 80% [13], [34]–[36]. Our results suggest that some GPs hesitate to prescribe antidepressants even in severe MD.…”

“…Most existing information is also limited by the inability to control for patient characteristics [13]. Finally, studies of GP attendees may suffer from important selection biases due to the complexity of their implementation and thus the likelihood that both GPs and patients will perceive them as intrusive [5], [14].…”

Predictors of Primary Care Physicians’ Self-reported Intention to Conduct Suicide Risk Assessments

“…For the current study, the authors conducted a secondary analysis of a subset of data collected as part of a larger study, the Physicians’ Decisions for Depressed Medically Ill Study. 16 Because a comprehensive description of the larger study can be found elsewhere, 16 the authors describe it concisely here.…”

Dentists Make Larger Holes in Teeth Than They Need to If the Teeth Present a Visual Illusion of Size

“…Simulation of conditions for diagnosis has involved showing practitioners video displays of actors portraying patients; this has shown various non-medical influences, such as age of the health-care provider and that of the patient, on diagnosis and decisions [23], [24], [25]. Although studies have suggested that visual illusions could affect diagnosis [16], [17], [18], [19], [20], [21], we are unaware of any that use simulation to take a prospective approach.…”