title: Psychotropic medication discussions in older adults' primary care office visits: So much to do, so little time.
abstract: OBJECTIVE
  To examine discussions of psychotropic medications during the older patient's visit to primary care physicians, identify how physician's competing demands influence these discussions, describe different scenarios physicians utilize to address mental health complaints of older adults, and recommend best practices for diagnosing and treating such patients.
  
  
  METHODS
  Convenience sample of 59 videotapes of primary care office visits involving mental health discussions in the United States complemented by patient and physician surveys. Videotaped visits were examined using logistic regression for grouped-level data to explore contributions of physician's competing demands to the likelihood of having psychotropic medication discussions. Tape transcripts were selected to provide examples of prescribing and referral behaviors.
  
  
  RESULTS
  One-third of these visits contained no psychotropic medication discussions despite its important role in treating mental illnesses. When prescribing psychotropic medicines, physicians presented information about the medication's purpose and brand name more often than adverse effects or usage. More competing demands (i.e., more topics discussed or more leading causes of disability addressed during the visit) were associated with less psychotropic medication discussions. Selected case scenarios illustrate the importance of acknowledging mental illness, prescribing psychotropic medications, explaining the medications, and/or referring patients to mental health providers to address their mental health complaints.
  
  
  CONCLUSIONS
  Competing demands may constrain discussions of psychotropic medications. Given the seriousness of mental illness in late life, system-level changes may be needed to correctly diagnose mental illness, take more proactive actions to improve mental health, and enhance information exchange concerning psychotropic medication in a manner that meets patients' needs.
authors.affiliation: Department of Social and Behavioral Health, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA. snahn@srph.tamhsc.edu
authors.forename: SangNam
authors.initials: S
authors.lastname: Ahn
authors.forename: Ming
authors.initials: M
authors.lastname: Tai-Seale
authors.forename: Charles
authors.initials: C
authors.lastname: Huber
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Smith
authors.forename: Marcia G
authors.initials: MG
authors.lastname: Ory
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D009819:Office Visits; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011787:Quality of Health Care; D014741:Video Recording; D016526:Workload
chemical_list: D011619:Psychotropic Drugs