Provider-patient communication about antidepressants among veterans with mental health conditions.
BACKGROUND
Little is known about provider-patient communication regarding antidepressants in primary care settings.


OBJECTIVE
The purpose of the study was to describe the extent to which veterans and their providers discuss anti-depressants during primary care visits, and to examine how patient characteristics are related to elements of this communication.


METHODS
This study is a secondary analysis conducted of a data set of audiotaped clinic visits and previsit interviews with 253 adult male veterans seen in primary care. The study patients who were provided an initial antidepressant prescription or continued on an antidepressant on the day of the audiotaped visit and who had a diagnosis of depression, posttraumatic stress disorder, or bipolar disorder were included in the current analysis. Audiotapes were coded using a reliable instrument. Descriptive and bivariate statistics were calculated.


RESULTS
Forty veterans (mean [SD] age, 58.9 [10.4] years) were eligible for study. Of these 40 veterans with a documented prescription for an antidepressant, 62.5% (n = 25) discussed these medications with their provider during the visits. If antidepressants were discussed, the provider initiated the discussion 68.0% (n = 17) of the time. Only 2 patients asked questions about their antidepressants. Thirty-two of the 40 veterans were continued users of anti-depressants; 8 began their antidepressant on the date of the audiotaped visit. Providers asked 15.6% of veterans (n = 5) on continued therapy how well their antidepressants were working and 6.3% of veterans (n = 2) on continued therapy about adverse effects. Among continued users of antidepressants, 18.8% (n = 6) expressed a complaint about their antidepressant and 21.9% (n = 7) of patients expressed an adherence problem.


CONCLUSIONS
To detect and prevent problems with antidepressant therapy, primary care clinics should consider having nonphysician health care personnel ask patients taking antidepressant medication at least one open-ended question about how the antidepressant is working, another about possible adverse effects or barriers to use, and a third about adherence.
Sleath
Betsy
B
Cecil G. Sheps Center for Health Services Research and the Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7590, USA. Betsy_Sleath@unc.edu
Tulsky
James A
JA
Peck
B Mitchell
BM
Thorpe
Joshua
J
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy; D003142:Communication; D003625:Data Collection; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010358:Patient Participation; D017060:Patient Satisfaction; D011320:Primary Health Care; D011369:Professional-Patient Relations; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy; D013637:Tape Recording; D014481:United States; D014728:Veterans / Q000523:psychology*
D000928:Antidepressive Agents