DENVER — Elderly patients who consult their primary care physicians about depression or other mental health problems often get short shrift because of competing time demands in a busy office practice, an analysis of videotaped physician-patient encounters indicates.
Of 392 videotaped office visits involving elderly patients and primary care physicians in an academic medical center or solo practice, 59 addressed mental health issues, including 35 involving depression or suicidal thoughts. Surprisingly, one-third of the office visits in which elderly patients reported experiencing mental distress contain no discussion of psychotropic medications, SangNam Ahn, Ph.D., reported at the annual meeting of the American Public Health Association.
On average, 11% of the content of physician-patient encounters involving mental health issues was devoted to discussion of psychotropic medications. When prescribing these medications, primary care physicians presented more information about the drug’s purpose and brand name than about adverse effects, proper usage, or cost. Possible referral to a mental health professional was discussed in 12 of the 59 analyzed visits. A referral was actually made in seven cases, according to Dr. Ahn of the Texas A&M University, College Station.
Primary care physicians discussed an average of 7.4 distinct health issues per office visit with these elderly patients. Moreover, the patients had an average of two causes of disability limiting their activities. The thoroughness of discussion about psychotropic medications in this study was inversely related to the number of topics addressed: Patients with seven or eight health topics discussed during their office visit had 41% less discussion of psychotropic medication than did those with six or fewer topics discussed, and patients with nine or more topics addressed had 83% less discussion of psychotropic medication.
These study findings have several health policy implications. One is that busy primary care physicians should be encouraged to loosen time bottlenecks by liberal referral of elderly patients with mental disorders to mental health specialists. In addition, good-quality patient information leaflets should be developed for distribution by primary care physicians who prescribe psychotropic medications to elderly patients. And the reimbursement structure should be reformed by broadening reimbursement for telephone consultation and coordination of care, Dr. Ahn proposed.
Dr. Ahn declared having no relevant financial interests.