Screening for depression in patients in long-term care facilities: a randomized controlled trial of physician response.
OBJECTIVE
To determine the effect of a screening protocol using the Geriatric Depression Scale (GDS) on the frequency of primary care physicians' decisions to prescribe drug therapy or refer long-term care patients with possible depression to mental health care.


METHODS
Case-finding phase, followed by a randomized controlled trial of the effect of a physician-targeted intervention on antidepressant prescribing or referral to mental health services.


METHODS
Twenty-two nonacademic long-term care facilities.


METHODS
One hundred three of 1,602 patients aged 65 and older who met criteria for cognitive function and untreated symptoms of depression.


METHODS
The 77 physicians of these patients were randomized as clusters into an early notification (experimental) or a delayed notification (control) group.


METHODS
Frequency of physician response (mental health consult or antidepressant therapy) at 4 and 8 weeks from notification, physician follow-up, and factors associated with physician response.


RESULTS
Frequency of physician response in the early group (25%) was greater than in the delayed group (2%) (P <.005) 4 weeks from baseline. Physician response rate when the groups were combined was 36% (95% confidence interval (CI) = 26%-46%) 8 weeks from notification. Overall, there was evidence of physician action after letters of notification in 69% (95% CI = 60%-78%) of cases. Univariate logistic regression suggested that physicians' decisions were primarily associated with physician-related characteristics.


CONCLUSIONS
Screening of long-term care patients for depression can increase the frequency of treatment or referral by primary care physicians.
Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC, Canada V6T 1Z3.
Judith A
JA
Soon
Marc
M
Levine
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010821:Physicians, Family / Q000592:standards*; D012017:Referral and Consultation; D012866:Skilled Nursing Facilities / Q000592:standards*