title: Two-minute mental health care for elderly patients: inside primary care visits.
abstract: OBJECTIVE
  To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients.
  
  
  METHODS
  Mixed-method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health.
  
  
  METHODS
  Three types of settings: an academic medical center, a managed care group, and fee-for-service solo practitioners.
  
  
  METHODS
  Thirty-five primary care physicians and 366 of their elderly patients.
  
  
  METHODS
  Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk.
  
  
  RESULTS
  Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients.
  
  
  CONCLUSIONS
  Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits "during which a mental health problem is discussed" may need to be supplemented with guidelines about what should happen during the visit. System-level interventions are needed.
authors: Texas A&M Health Science Center, College Station, Texas, USA. mtaiseale@srph.tamhsc.edu
authors: Ming
authors: M
authors: Tai-Seale
authors: Thomas
authors: T
authors: McGuire
authors: Christopher
authors: C
authors: Colenda
authors: David
authors: D
authors: Rosen
authors: Mary Ann
authors: MA
authors: Cook
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D009819:Office Visits; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D014481:United States; D014743:Videotape Recording