Understanding primary care physicians' propensity to assess elderly patients for depression using interaction and survey data.
OBJECTIVE
The objective of this study was to examine primary care physicians' propensity to assess their elderly patients for depression using data from videotapes and patient and physician surveys.


METHODS
An observational study was informed by surveys of 389 patients and 33 physicians, and 389 videotapes of their clinical interactions. Secondary quantitative analyses used video data scored by the Assessment of Doctor-Elderly Patient Transactions system regarding depression assessment. A random-effects logit model was used to analyze the effects of patient health, competing demands, and racial and gender concordance on physicians' propensity to assess elderly patients for depression.


RESULTS
Physicians assessed depression in only 14% of the visits. The use of formal depression assessment tools occurred only 3 times. White patients were almost 7 times more likely than nonwhite patients to be assessed for depression (odds ratio [OR], 6.9; P < 0.01). Depression assessment was less likely if the patient functioned better emotionally (OR, 0.95; P < 0.01). The propensity of depression assessment was higher in visits that covered multiple topics (OR, 1.3; P < 0.01) contrary to the notion of competing demands crowding out mental health services. Unexpectedly, depression assessment was less likely to occur in gender and racially concordant patient-physician dyads.


CONCLUSIONS
Primary care physicians assessed their elderly patients for depression infrequently. Reducing the number of topics covered in visits and matching patients and physicians based on race and gender may be counterproductive to depression detection. Informed by videotapes and surveys, our findings offer new insights on the actual care process and present conclusions that are different from studies based on administrative or survey data alone.
Tai-Seale
Ming
M
Texas A&M Health Science Center School of Rural Public Health, College Station, TX TX 77843-1266, USA. mtaiseale@srph.tamhsc.edu
Bramson
Rachel
R
Drukker
David
D
Hurwicz
Margo-Lea
ML
Ory
Marcia
M
Tai-Seale
Thomas
T
Street
Richard
R
Cook
Mary Ann
MA
D000368:Aged; D003863:Depression / Q000175:diagnosis*; D005006:Ethnicity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010817:Physician-Patient Relations; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D012737:Sex Factors; D012959:Socioeconomic Factors; D014743:Videotape Recording