title: Treatment decisions on antidepressants in nursing homes: a qualitative study.
abstract: OBJECTIVE
  To explore decision-making on treatment with antidepressants among doctors and nurses in nursing homes.
  
  
  METHODS
  A qualitative study based on interviews with three focus groups comprising eight physicians engaged full time, eight physicians engaged part time, and eight registered nurses, respectively. The interview guide comprised questions on initiating, evaluating, and withdrawing treatment with antidepressants. The interviews were audio-recorded, transcribed, and analysed by systematic text condensation.
  
  
  RESULTS
  The first theme was the diagnostic process. The informants expressed difficulty in differentiating between depression and sorrow resulting from loss in old age. Further, the doctors reported that they relied on nurses' observations and rarely carried out systematic diagnostic work and follow-up of patients with depression. The second theme was treatment. Antidepressants were usually the only type of treatment provided, and patients were kept on medication even though staff felt uncertain whether this was effective. The third theme was who really determines the treatment. Registered nurses reported that unskilled and auxiliary nursing staff requested drug treatment, and doctors felt some pressure from the nurses to prescribe antidepressants.
  
  
  CONCLUSIONS
  This study suggests that the quality of diagnosis and treatment for depression in nursing homes needs to be improved in Norway. Doctors should be more available and take responsibility and leadership in medical decisions.
authors: Research Unit for General Practice, Uni Health, Bergen, Norway. kristina.iden@gmail.com
authors: Kristina Riis
authors: KR
authors: Iden
authors: Stefan
authors: S
authors: Hjørleifsson
authors: Sabine
authors: S
authors: Ruths
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003657:Decision Making; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy; D017144:Focus Groups; D005500:Follow-Up Studies; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D009726:Nurses / Q000523:psychology; D009735:Nursing Homes; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D000078329:Workforce
chemical_list: D000928:Antidepressive Agents