The role of provider attitudes in prescribing antidepressants to older adults: leverage points for effective provider education.
OBJECTIVE
The purpose of this study was to determine if primary care provider knowledge of late-life depression, attitudes about treatment of depression in late life, and experience treating late-life depression affect the likelihood internists would prescribe antidepressants to older patients.


METHODS
This study was a primary care provider survey study. From a pool of 456 eligible mailed surveys, 253 providers completed (55% response rate) a survey assessing provider self-reported knowledge about treating late-life depression with antidepressants, their attitudes about older patients' acceptance and response to antidepressant medications, their professional and personal experience with antidepressant medication, and their comfort with prescribing antidepressants to older patients was created for this study.


RESULTS
Univariate analyses indicated that 75% of primary care providers were knowledgeable about the use of antidepressant treatment in older people, and 86% said they felt comfortable treating depression in older patients. Multivariate analyses indicated that the decision to treat older patients with antidepressants was largely influenced by time to treat patients, provider belief that antidepressants could treat late-life depression, their comfort with treating late-life depression, and having had older patients respond to antidepressant treatment in the past (R2 = .52, p < .001).


CONCLUSIONS
This study shows that attitudinal and experiential factors play an important role in the likelihood that a provider will treat an older, depressed patient with an antidepressant, more so than knowledge about how to prescribe an antidepressant to older patients. Residency programs for primary care practitioners should include education about the efficacy of antidepressant treatment in older people and should involve hands-on experience in treating late-life depression.
Areán
Patricia A
PA
University of California, San Francisco, Department of Psychiatry, 94143-0984, USA. pata@lppi.ucsf.edu
Alvidrez
Jennifer
J
Feldman
Mitchell
M
Tong
Lowell
L
Shermer
Rebecca
R
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003071:Cognition; D003863:Depression / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012380:Role; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents