title: Providers' attitudes towards treating depression and self-reported depression treatment practices in HIV outpatient care.
abstract: Depression is highly prevalent among HIV-infected patients, yet little is known about the quality of HIV providers' depression treatment practices. We assessed depression treatment practices of 72 HIV providers at three academic medical centers in 2010-2011 with semi-structured interviews. Responses were compared to national depression treatment guidelines. Most providers were confident that their role included treating depression. Providers were more confident prescribing a first antidepressant than switching treatments. Only 31% reported routinely assessing all patients for depression, 13% reported following up with patients within 2 weeks of starting an antidepressant, and 36% reported systematically assessing treatment response and tolerability in adjusting treatment. Over half of providers reported not being comfortable using the full FDA-approved dosing range for antidepressants. Systematic screening for depression and best-practices depression management were uncommon. Opportunities to increase HIV clinicians' comfort and confidence in treating depression, including receiving treatment support from clinic staff, are discussed.
authors: Center for Health Policy and Inequalities Research, Duke University Medical Center, Durham, North Carolina 27705, USA.
authors: Kiana D
authors: KD
authors: Bess
authors: Julie
authors: J
authors: Adams
authors: Melissa H
authors: MH
authors: Watt
authors: Julie K
authors: JK
authors: O'Donnell
authors: Bradley N
authors: BN
authors: Gaynes
authors: Nathan M
authors: NM
authors: Thielman
authors: Amy
authors: A
authors: Heine
authors: Anne
authors: A
authors: Zinski
authors: James L
authors: JL
authors: Raper
authors: Brian W
authors: BW
authors: Pence
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration; D000554:Ambulatory Care Facilities; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents